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

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

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

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

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...