Asked, Answered
Monday, November 24 2008
Kevin, MD asks: what do patients think of the medical home? Well… I can’t speak for all patients, but I can certainly pretend I do.
So Kevin links to Maggie Mahar’s post about medical homes, which she describes thusly:
… primary care should be more “team-based,” with “many functions from the 15-minute visit” offloaded to medical “extenders” such as nurse practitioners and physician assistants, all working within the same practice as the PCP. (This is the core idea of the much-vaunted medical home model of primary care).
How do I feel about that idea? I think it’s great. I’ve been convinced for a while now that NPs and PAs should be doing a lot more front-line care – that they should have a much bigger role in our medical system. For routine stuff, I actually prefer a PA or an NP.
As an example: I went to the local ER/Urgent Care last spring for a cut finger – a stupid kitchen accident and entirely humiliating. I never saw a doctor at the hospital; instead, a PA gave me a tetanus booster and four stitches, and I was on my way after about thirty minutes total. Then I tried to arrange an appointment with my primary practice to get the stitches out. She was booked, so I saw another doctor, who removed the stitches. It struck me as ridiculous that I (or my insurer) was paying a doctor to do what a PA could have done – heck, what I could have done with sterilized nail clippers.
So, yes – bring on the “extenders”. If medical homes become widespread, there will still be patients who insist on seeing a physician always, and they’re idiots. More people – probably most – will recognize the efficiency that PAs and NPs offer, if only because seeing a physician requires so much waiting. In fact, I suspect the medical home concept will catch on pretty quickly, once it gets going. Moreover, it’s going to be most readily accepted by the heaviest users: the chronically ill people who already spend half their lives in waiting rooms, shuttling between referrals, and arranging their calendar around their physician’s.
I should point out that one of the things informing my views is that I know what’s involved in PA training. For some patients, the phrase “physician’s assistant” suggests an administrative or clerical position, which is off-putting. That should change, but it is a minor obstacle for the time being.
