I want to share a recent anecdote from my clinic which highlights how patient centered family medicine is cost effective and simply good care for patients.
I saw Mr. F, a 75-year-old gentleman. Like many of my patients, he has a history of high blood pressure and obesity. He also had a heart attack in the past as well as two additional stents placed in his coronary arteries. I was seeing him in follow up to his hospitalization. Given the patient centered medical home (PCMH) model that Kaiser Permanente uses, I could easily pull up all the labs and notes from his hospitalization, as well as his cardiac catheterization report. There was no need to track down charts or wait for faxes or notes from other hospitals or clinics. His entire medical history was right there on the screen for me to see and browse. I could easily determine that his cath went well and he had good flow to his heart muscle and had an uncomplicated postoperative course. He was doing well and no longer experienced chest pain or shortness of breath at rest or while walking. He wanted to get back to an exercise routine, but was afraid to do so. We discussed his heart disease, symptoms with physical activity and ensured he was on proper medication to reduce his risk of further complications.
At the end of the visit, he brought up several other concerns not initially listed as the reasons for his visit that day. He had some questions about his blood sugar and whether he should be checked for diabetes, as well as a growth on his face. He had not been tested in the past eight years and, given his heart disease and high blood pressure, we decided we should check.
He had already made an appointment with a dermatologist for further evaluation of the growth on his face, but he could not get in to see them for more than two months. I looked at his entire medical history on our electronic medical record and discovered he had a history of skin cancer. I evaluated his lesion and was concerned that it was cancerous. I did not want him to wait two months for care. As a family physician, I am trained in full scope of care and felt very comfortable taking a biopsy of the lesion then and there. Furthermore, my next patient had not yet arrived for his appointment, so I decided to take my care a step further and remove the entire lesion with an elliptical excision. The pathology results came back three days later. It was, indeed, skin cancer and the margins were clear, meaning it had been totally removed and there was no need for urgent follow up.
This is what patient centered, family medicine care looks like. The patient only had to come to one appointment, pay one copay, see his primary care physician whom he already knew and who also possessed his complete medical record. There was no need for multiple visits, multiple copays, multiple biopsies, tracking down charts and records, returning phone calls, etc.
It is important to keep in mind I could provide this care because of several important factors, most of which did not happen by accident. First, I had easy access to his entire medical and medication history. Second, I had enough time with the patient. Third, I had the support staff and equipment necessary. Fourth, I had the proper training in both dermatology and minor procedures. Finally, and most importantly, the patient and I had a relationship in which trust and understanding had been built that allowed this type of care to be performed on the spot.
Our medical system is fraught with redundancy, waste and added cost, much of which can be eliminated by strong, patient centered, full-scope primary care. Let’s continue to build our primary care networks, encourage aspiring doctors to understand the importance of primary care, utilize technology to ensure patients receive high quality, appropriate care and provide primary care doctors the compensation they deserve to provide complete care at each and every visit.
Alex Mroszczyk-McDonald, MD
PGY-3 Family Medicine
Kaiser Permanente Fontana