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Steps Toward Creating a Patient-Centered Medical Home

February 9, 2011
by James L. Holly, M.D.
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The only care which benefits a patient is the care which they can access. Though I know all there is to know about treating a complex medical condition, only the care the patient can afford or can obtain improves their health. This reality has major medical, social, political and economic implications.

On February 16, 2009, this writer attended a conference in Houston on Patient-Centered Medical Home. As I drove to the conference, I said to my colleagues, "If I am going to listen to someone read a PowerPoint presentation to me, I am going to be aggravated." I was aggravated. I came away from the lecture knowing no more about what Patient-Centered Medical Home really is than I did before.

The next morning, while making rounds, I met the incarnation of "medical home." That incarnation was in the form of an angry, frustrated, hostile, and belligerent patient. Nothing I could say dissuaded this person from their anger. As a result, I asked the patient to see me personally in follow-up. Keeping the office appointment, that was no different, but in the visit I discovered the following:

  1. The patient was disabled and could not pursue his job.
  2. The patient was taking only four of his nine medications as he could not afford all of them.
  3. The patient was losing his eyesight due to his underlying illness.
  4. The patient could not afford the gas to come to education class which might help him improve his health.
  5. The patient could not afford the co-pays for education classes.

After evaluating the conditions for which he was hospitalized, he left with the following:

  1. All of his medications, paid for by the SETMA Foundation, a 501c3 foundation established by the partners of SETMA to help their patients receive the care they need. In 2009 alone, SETMA partners contributed $500,000 to the Foundation.
  2. A gas card from the foundation so that he could afford to come to education classes.
  3. The co-pays waived for the education classes.
  4. Help in applying for disability income.
  5. Referral by SETMA's Ophthalmologist to a research program in Houston which could help preserve his eyesight.

Though we did not yet understand all there was to know about Patient-Centered Medical Home, we recognized that we had just experienced it. Six weeks later, this patient returned with a smile on his face and with his winsome personality apparent. He had something we could not prescribe. He had hope and his illness was treated to goal for the first time in several years.

Address to Graduating Class at School of Medicine

On May 22, 2010, this author gave his last greeting as President of the Alumni association to the graduates of the University of Texas Health Science Center at San Antonio School of Medicine. That greeting incorporates many of the realities of healthcare today. It stated:

"As you stand today to receive the symbol of a lifetime of achievement -- your doctor of medicine diploma. -- you stand on one hundred years of progress since Abraham Flexner challenged the nation with the need for a sound scientific foundation to the teaching and practice of medicine. Today crowns "a lifetime of achievement," for your medical education did not begin four years ago, nor will it end today.

"Without a doubt you are the smartest and most knowledgeable generation of physicians ever, and you fulfill every hope and expectation of the 1910 Flexner report. Yet, contained in that report was a potential unintended consequence: the possible replacement of a personal, trusting physician/patient relationship with a trust only in technology.

"You face the reality that the only care which will improve the health of your patients, while based on your knowledge, is the care they are able to access and receive. You face the dilemmas created by the success of scientific progress, which are:

  • "How do I balance technology with humanity?"
  • "How do I overcome the seduction of entrepreneurism which has eaten at the soul of medical professionalism like a cancer?
  • "How do I re-establish patient confidence in my counsel, supported by appropriate technology, rather than my patients simply trusting in more procedures, tests and operations?
  • "How do I balance the tension between more care and more health?"

"As your President, I welcome you to your alumni association. Your school and your colleagues need your participation and support. Welcome to the future of a profession which not only desires to help others to live longer but to help them have a life every day they live.

"Today, we pass the healthcare leadership baton to your generation of physicians. We will carry it with you part of your journey, but if we all are to succeed, our hopes and passions must be incorporated into yours. We pass this baton to you confident of your fidelity to the profession you join and to the vision and mission of your University.

Congratulation and welcome to the task."

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    James Holly

    CEO, managing partner of the Southeast Texas Medical Associates (SETMA) in Beaumont

    James L. (Larry) Holly, M.D., After completing his medical education, James L. (Larry) Holly, M....