Direct patient care

by Greg Markway, MD

This is the first article contributed a member physician in lieu of our yearly printed newspaper supplement, dealing with the topic of direct patient care. Thank you, Dr Markway!

The evolution of the practice of family medicine is occurring on many different formats. At the basis of all of these changes is the recognition that the most important part of family medicine is the patient-physician relationship. These changes are being driven in some measure by the patients’ sense of loss of that integral part of their medical care. Too many times in recent years the forms of practice are driven by governmental, insurance and EHR (Electronic Health Record) dictates. All of these are examples of the economic pressures that physicians face to continue to keep their practices economically viable. The result of these pressures is that physicians have increased the volume of patients seen on a daily basis thereby extremely limiting the amount of time they able to spend with each individual patient. These changes have occurred regardless of whether the physician continues to own the practice or, as in most cases, the physician has sold his practice to a larger entity or become an employee of that entity.

These recent changes in the family practice model are a direct response of these time pressures. They allow the physician to return to the previous level of practice that values the patient’s needs and care as a central focus of their medical practice. These models allow an uncoupling of physician compensation from the demands of governmental, insurance and EHR providers. They reinforce the central relationship between physician and patient as the most important guiding force in the care of the individual. The most important impact this change in practice model has made is that it allows the physician to spend optimum amount of time with each individual patient. This allows a more genuine and deep relationship to develop that allows for a more comprehensive medical decision-making processes. This allows the physician to be more integrally involved in the patient’s care. The physician can then also act as a resource to the patient when dealing with consultations and hospitalizations to allow the patient a full understanding of his or her medical conditions.

These changes go by several different names whether they be called concierge medicine, direct patient care, or direct contracting. They are basically stating that the relationship between the patient and physician is the most important aspect of medical care. They reestablish the direct bond between patient and physician by allowing for improved availability to the patient in many aspects of their medical care. This includes 24/7 availability via the phone rather than required to negotiate a complex voicemail or switchboard system. It also means that the patients are seen in a timely fashion usually within 1 to 2 days of their call to the office for an appointment. The central theme of all of these practices is that the patient’s time and concerns are the most highly valued component of the practice management system. Appointments are very timely with minimal waiting time for the patient in the office.  The time allotted for each patient is greatly expanded to allow for a full conversation of the patient’s current concerns as well as the complete review of ongoing medical processes. This allows the physician to be truly the patient’s advocate in all aspects of their medical care and reinforces the value of the patient’s opinions and concerns. It is through these changes family medicine as a specialty becomes increasingly attractive to young physicians trying to decide their choice of specialty. This represents a preservation of family medicine as a viable option for medical students. It allows young physicians to see family medicine as truly different from other primary care specialties.  Although it was stated in the beginning that this represented an evolution in the practice of family medicine it must be apparent by now that this is in fact a return to the previous commitment of the family physicians to their patients that is always been the hallmark of Family Medicine.