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?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Patient Centered Nonsense Needs to Go Away

  1. Pat
    April 26, 2017 at 11:25 am

    That’s the thing about Potemkin villages – you aren’t supposed to walk around and look at the back side where they didn’t paint, and the peasants didn’t dress up.

  2. Perry
    April 26, 2017 at 9:32 am

    I think Patient-Centered Medical Care is a bit redundant. It’s like saying my plumber is “toilet-centered”.

  3. Thomas Guastavino
    April 26, 2017 at 8:45 am

    Can someone tell me who are the morons that constitute the “Institute of Medicine” ? They need a good talking to before they do any more damage.

    • Kurt
      April 27, 2017 at 2:32 pm

      I will give you the anagram for these authorities, I. T. A. B.’s for Ivory Tower Academic
      Bas***ds. I have ’em for the AAFP and ABFM but too vulgar for an open forum and I am
      trying not to get censored by Doug. Hence a tempering of my discourse.

  4. RSW
    April 26, 2017 at 8:42 am

    If something is labeled as “patient centered,” it’s a given that:

    1. it has absolutely nothing in common with what my patients say they want from their medical care; and

    2. it will require lots of time sitting in front of the computer.

    What a scam.

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