Medical Homes, Yea or Nay?
- 0Jun 26, '09 by KatnipInteresting idea. The concept is to have people going back to one primary care provider-a general practioner or internist who takes care of most things. Kind of like the old days. The interesting thing is that at least in the featured physician's office, nurses take on a large role in assessing and educating the patient.
- 0Jun 26, '09 by emmalou*I absolutely agree with this concept.
I understand the US is undergoing some change with regard to your health care. We have a social healthcare system in Australia and are encouraged to see GPs rather than go to emergency rooms, which I agree with, however a lot of us still have problems finding a GP who will oversee all of our basic healthcare needs. Too bad if you want to get in to see them in under a week as well, unless you want to see another GP.
I find myself (in my 30s no less, a time when you should be looking at your heatlhcare more seriously), requesting my GP to refer me for bloods (chol, blood glucose etc) and I can't remember the last time my BP was taken as I keep forgetting to ask them to do it (?! :icon_roll). They are good (?overly cautious) with some things (PAP smears, mammograms for example are a big focus here) but with other things not so much. There is research which suggests we are over managed in terms of screening for PAPs and mammograms which are yearly to two yearly, depending on your circumstances - we seem to be one of the countries where patients have the most unnecessary invasive procedures (such as breast biopsies for abnormalities in scans, moles being removed because they look suspicious rather than a wait and see approach, treatment for women with abnormal PAP smears which are low level). Not saying these things shouldn't be done, they obviously save people's lives, but I've had 2 procedures myself, around ten years apart for dodgy PAP smears which were largely unnecessary due to the low level abnormality but because of this history, my current GP insists I need a yearly PAP (I am awaiting HPV test results to find out if I need to continue this but am going off the track now).
In my country, GPs are becoming pretty thin on the ground, due to probable burnout and not much money or respect for such an important job (sounds like another type of job eh?) but I am paying them to look after my health - admittedly only about half the actual cost but still, I shouldn't need to ask them to send me for tests.
On paper at least, we have a system which advocates patients being pro-active and preventing ill-health by lifestyle changes, however we are still at the mercy of pharmaceutical companies dictating to doctors and patients the advantages of popping a pill so money is obviously a factor.
I'm mostly happy with the healthcare here, but it's definitely gone downhill.
- 0Jun 27, '09 by mykidzmomugh. yes, it is a good idea. i'm sure it improves care. doctor gets to be marcus welby, patients get to be taken care of well and his nurses get to....keep track of the records and sit quietly by while he does the real work ? not sure that is what his nurses went to school for--data collection and filing. perhaps what is left out of the article (i don't know, of course) is that the NURSES are doing the education for preventative and chronic conditions. it is hard for me to evaluate the merits of what they are suggesting when all i can see is how great the doctor is doing by having the nurses do his scut work. maybe that is what has been wrong with our broken health care system all along! us pesky, uppity nurses trying to compete with those doctors. everything was just fine when we took his notes and sat in the room with him. sorry, this kind of thing makes me bristle. i worked too hard to become a nurse to praise this type of article.
- 0Jun 27, '09 by kat7apQuote from mykidzmomThe article actually describes more of what the nurses are doing: "Anderson's nurses spend about 30 minutes with each patient on each visit, working through a long list of questions, assessing new health problems, and reviewing old ones. The nurses also discuss preventive measures and treatment options". I wonder if this would this mean that only licensed nurses could do this position or would medical assistants be substituted?ugh. yes, it is a good idea. i'm sure it improves care. doctor gets to be marcus welby, patients get to be taken care of well and his nurses get to....keep track of the records and sit quietly by while he does the real work ? not sure that is what his nurses went to school for--data collection and filing. perhaps what is left out of the article (i don't know, of course) is that the NURSES are doing the education for preventative and chronic conditions. it is hard for me to evaluate the merits of what they are suggesting when all i can see is how great the doctor is doing by having the nurses do his scut work. maybe that is what has been wrong with our broken health care system all along! us pesky, uppity nurses trying to compete with those doctors. everything was just fine when we took his notes and sat in the room with him. sorry, this kind of thing makes me bristle. i worked too hard to become a nurse to praise this type of article.
- 0Jun 27, '09 by cjcsoon2brn, BSN, RNIts a very interesting idea. I think it has the potential to help improve American healthcare in a really big way. What we really need to do is to refocus our healthcare system to emphasize primary medicine and getting back to the basics. We get so caught up in new procedures and technology that we stumble over the foundations of medicine which is preventative medicine and wellness. We might take a page from Japan's healthcare system that insists that all retirees must receive a physical by a generalist at least once a year and in turn all of their healthcare costs are covered by the government.
- 0Jun 28, '09 by JericoDocs attempt to crush Nurse Practitioners in the U.S. because of money territory. Until that changes AFFORDABLE access to health care in the U.S. (and in other countries) is going to go nowhere with or without insurance/health care reform.
Example: Doc does pap smear procedure. Charge $135.00
NP does pap smear procedure. Charge $70.00
Another example is nurse anesthesiologists! Doc anesthesiologists hate them because they are horning in on their territory. It is COMPETITION for the supply of patients. If there are more providers (add NPs and PAs) docs can't charge as high of rates. The docs need to charge higher to pay off all the darn loans they are in for medical school. Solution: change the medical school costs, or give more grants for NPs, Docs, PAs to be trained.
It is the SAME procedure, the NP and DOC have done the exact same thing! Same time, everything; but because the patient gets doctor face time, (even if they discuss nothing, and usually NPs discuss MORE than a doc with patients) the insurance pays higher for the doc. Doesn't make any sense at all.
Procedure done by LICENSED NP, DOC should be paid the same: $70.00.
Now, make a clinical consult MD charge, wherein the NP refers the issue to a doc with all the notes done by the NP so far, at patient request OR because NP can't figure issue on own, and then charge more...for doc expertise?
Medical charge increases are simply a territory thing...docs don't want NPs taking over turf, because it brings prices down...or patients and insurance companies would rather use NPs because they are cheaper.
- 0Jun 29, '09 by MedSurgeMessI know a couple of docs in my community who feel that this is the wave of the future. They are having trouble with the rest of the medical community in our area who argue about its adoptability; ie, "we docs may have to give a little something up for our patients" (as said by the 2 docs, not me). I think being able to work on prevention would be so AWESOME!