The Real Reason Why Docs Like Care Management and the Medical Home

Handle it for me, will you?

Writing in the latest issue of the New England Journal, HHS Deputy Assistant Secretary for Health Dr. Anand Parekh argues that the physician road to winning patients' trust is lined with the adoption of behavioral medicine in day-to-day health care.  If done right, patients will feel "empowered, informed, motivated and involved."  He says there is good evidence that when physicians personally prescribe behavior change in the context of a trusting doctor-patient relationship, clinically and statistically significant shifts in patient behavior follows.  Interdisciplinary and team approaches can help physicians fulfill this.  What's more, the trend toward global and outcomes-based payments will accelerate it.  Then the skies will part, and the heavenly host will descend, singing to the glory of a new age of wonderful outcomes and widespread healing.

The Disease Management Care Blog appreciates the vision, but, unfortunately, it has little correlation with the reality of clinical practice, physician professional development or the true appeal of the current reforms that are underway in primary care.  The real purpose of the population-based care management and the Patient Centered Medical Home (PCMH) is to create systems of care which unburdens doctors from having to perform the work of patient counseling.

What accounts for this DMCB apostasy?   It has observed that most physicians go to medical school and endure years of post-graduate training because they want to be doctors and do stuff like diagnose, treat and cure. Most just don't have the interest, expertise or patience to handle the increasingly sophisticated and complicated science of behavior change.  That doesn't mean that they don't appreciate it.  Rather, they know there is ample evidence that non-physicians are just as able - with the right kind of physician back-up - to handle the "heavy lifting" of one-on-one patient counseling and behavior change.  And under global payment systems so admired by Dr. Parekh, physicians will use part of that revenue stream to finally do what Medicare has been unable to do: pay nurses and other non-physician professionals to do the right thing for beneficiaries.

Physicians should be responsible for making it happen, but that doesn't necessarily mean that they personally should do it.  That means handing it off and getting out of the way.