Wednesday, December 22, 2010

Guest Blog: Family medicine's influence: let's talk!

Pat Jonas, MD is the president and medical director of Family Health Connections, Inc., a family-focused and holistic medical practice in Dayton, Ohio. He produces a weekly Blog Talk Radio show on Tuesdays from 8-9 PM Eastern on his blog, Dr Synonymous, where the following post was first published.



"You are a scarce, valuable resource," I told my colleague about 20 years ago when he felt rejected by the local hospital when bumped out of the practice he had served since proudly joining the family physician who had delivered him and cared for his family. He was inspired by the man who had served the community so well, eventually for over fifty years, and became a family doctor, just like his role model and mentor. Now, he saw the practice, in the neighborhood where he grew up, that he inherited at his mentor's retirement and merged into the hospital network to help with recruitment and management, redirected away from his philosophy of care toward hospital corporate values. What happened? Why did they close the office and order him to take the patients and practice where another recently trained family physician had been placed in practice two years ago in another retired physician's office in another neighborhood?

Hospital administrators think differently than physicians. Family physicians may even think differently than many other physicians. We care about our patients and their well-being. We haven't taken the time to verify our thought processes and our differences with hospital managers and other physicians. We need to clarify our similarities and differences now, though. We have to find our areas of mutual interest and mutual misalignment. We have to agree to disagree on many issues because of differing philosophies and business models. A creative tension between family physicians and hospital leadership benefits patients and the local economy.

Hospitals need to fill beds, CT scanners and cardiac cath labs. Patients don't want to fill them unless there is a clear need. If there are excessive medical resources such as CT scanners and cath labs, there will be a push to fill them by changing decision thresholds to use them. The creative tension between family physicians and hospital leaders can serve to find a balance in use of resources. As the family physician becomes a more scarce, valuable resource, their influence in hospitals is needed even if their presence is diminished. We are one of the keys to decreasing re-admissions of patients. We are key influencers of how our patients use health care resources, e.g. which hospital they relate to and where they go for physical therapy. We are key translators of healthcare system intentions to our patients. We are important communicators with small employers and some large employers in communities. We are trusted.

Let's get some better communication going between family physicians, hospitals and employers. It will better serve our patients and communities.