Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The medical home requires building a better team

Fred N. Pelzman, MD
Policy
August 25, 2013
Share
Tweet
Share

How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?

Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.

As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to click all their administrative boxes, to keep their supervisors happy, to keep the patients happy, to keep our customer satisfaction scores up, that no one really has the time or the support to even figure out how to act like a team.

Sometimes what it feels like we need to do is stop, slow down, take a deep breath, and really look at what it is we’re trying to accomplish here. Is what we are doing really in the best interest of our patients?

As Dr. Paul Batalden (one of the leading thinkers in healthcare improvement) has said, every system is perfectly designed to achieve exactly the results it gets. Clearly, what we are getting is not what we want. So we’d better design a different system.

First, we need buy in. Getting all the members of the potential team together, all at the same table, all convinced of the need to make these changes in the systems we use to take care of patients.

Perhaps the registrars at the front desk are not used to thinking about themselves as a member of a team. They see themselves as arriving in the morning for a job, punching a time clock, sitting at their computer station, answering phones, checking patients in, processing referrals.

Rewriting their job descriptions, re-tasking them so they feel ownership of the patients and the practice (and are appreciated and compensated as such) will be some of the difficult but necessary steps to take.

But we need more than lip service, more than simple platitudes or niceties to convince them that really engaging in the process of care is important, that they are an important part of the healthcare team.

Yet we do a poor job of integrating them into that team. And sometimes we don’t recognize that they (and many others) can make the lives of our patients better.

Recently a nearly blind, mildly demented, non-English speaking patient of mine was mailed a referral instructing her to set up an appointment on her own for neurocognitive evaluation. That is the way referrals are processed here. But the patient could not see or read the information on the paper, and could not have fathomed what to do with that information if she had been able to.

One of the registrars noticed on her return visit that she had not made the appointment, and gently, almost lovingly, guided her through the process right there at her desk. Maybe not the most efficient way, maybe not the way the system was set up for referrals, but it got the job done. And everyone felt better.

That registrar was a member of the team.

ADVERTISEMENT

We need to help all the members of the team see these patients as their responsibility, their mission, and that their day-to-day job involves more than just the busy work and the administrative work. That it involves the actual caring, the taking care of the patients, helping them to achieve better health.

We are going to be breaking apart the traditional mold, recreating the roles of all those involved, to build a better team.

Fred N. Pelzman is associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home. 

Prev

Medicare places hospitals in a discharge conundrum

August 25, 2013 Kevin 3
…
Next

The initial cut of the surgeon is a leap of faith

August 25, 2013 Kevin 5
…

Tagged as: Primary Care

Post navigation

< Previous Post
Medicare places hospitals in a discharge conundrum
Next Post >
The initial cut of the surgeon is a leap of faith

ADVERTISEMENT

More by Fred N. Pelzman, MD

  • Why electronic medical records should be standardized

    Fred N. Pelzman, MD
  • Can answers to after hours calls be automated?

    Fred N. Pelzman, MD
  • We have to do better than DNR tattoos

    Fred N. Pelzman, MD

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

      Trevor Cabrera, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • How trust and communication power successful dyad leadership in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 23 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

      Trevor Cabrera, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • How trust and communication power successful dyad leadership in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The medical home requires building a better team
23 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...