Patient Centered Nonsense Needs to Go Away

Remember when the whole Patient Centered Medical Home crap came out years ago?  Remember when I shredded the whole concept as bogus?  Well, if you don’t then here is something from 2012 and here is something from 2013 but you can search in the lower corner of this blog using the term PCMH and see how many times I have been screaming about this hoax.  Now a study in the American Journal of Medicine has validated me. It is called Diminishing Patient Face Time in Residencies and Patient-Centered Care and here is the abstract:

One of the more important recommendations coming from the Institute of Medicine’s seminal report on medical errors was the pressing need to implement patient-centered medical care. Although emphatically endorsed and highly influential, adoption of its 6 dimensions in “real life” has been slow, uncommon, and imperfect in most settings studied.

This report was looking at medical residents but I am sure it carries over the regular doctors as well.  Some more from the report:

  • Internal medicine residents spent 12% of their time in direct patient care versus 40% of their time using the computer and 15% on educational activities.
  • First-year residents rotating on the general medicine ward who were on call, yielding remarkably similar results: 12% of the time was spent on direct patient care and 40% on computer work, whereas education was limited to just 2% of on-call time.
  • Looking at residents’ “typical work day” schedules found that interacting with patients constituted 9% of the work day (67.8 minutes) compared with 51% spent on computer work and 11% on rounds.
  • Learning activities also are meager: In one study, just 5.8 minutes per 12-hour shift were devoted to looking up information.

Trust me folks, it’s not that much difference with real world docs.  The only exception, however, being Direct Primary Care doctors.  We love seeing these reports because it does all the advertising for us.

Just because you create a new term like Patient Centered Medical Home doesn’t mean it is going to work. It turns out that you need to spend time with the patient in order to be patient centered.  Creating all the other superfluous bullshit like quality metrics and arbitrary metrics only takes residents and doctors away from the patient.  Can we please finally learn from this?

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