Tuesday, February 24, 2009

Oh give me a home

If you are looking for a medical home, pal, newFNP's clinic ain't it.

Truly, in no way does newFNP's ramshackle community health clinic meet the criteria for a medical home.  Access to one's regular provider* and a personal relationship with this person?  No.  Evidence based practice and support for providers?  Nope.  Expanded access to one's primary provider via phone or email?  Sorry, no.  Comprehensive care?  Yeah - no.  Reasonable wait times?  Ha!  That might be the most blatant 'no' of all.

Jesus, newFNP is a little bummed just thinking of all the ways in which her clinic sucks.  

When newFNP thought of how she wanted to impact the well-being of the urban poor, she thought that she would help her patients to achieve health and thereby the ability to work given that they are - you know - not having MIs and diabetic retinopathy and teenage pregnancies.  In her obviously skewed and possibly delusional pre-community health clinic mindset, access to healthcare led to health which led to well-being which led to productivity which led to the promise of financial stability and a brighter future for themselves and their families.

Ha!  What the hell??!?  Where has that wide-eyed girl gone?  It's hard for newFNP to imagine herself being so idealistic.

There are times in which newFNP wonders exactly what good she is doing when her patients wait five hours to see her for a follow-up visit.  

As newFNP has mentioned, her days have become busier since pulling back on her clinical hours.  During this transition, newFNP has noticed a change.  Her patients are waiting to see her despite the ridiculously long wait.  

They come to clinic on newFNP's assigned days and wait.  When they are assigned to other providers on a given day, they advocate for themselves and assert that they will wait rather than being cared for by someone whom they do not know.  Of course, this is normal and the ideal situation - patients should not have to explain their diagnoses and personal situations over and over again.  But newFNP just loves that these patients dig in their heels and say no.

They are medical homesteaders.

If newFNP was running the show, she would make one small change that might decrease the wait times for her loyal patients - and all of her other patients as well.  She would schedule her patients on her actual schedule.  

Seriously people, where is newFNP working?  In a fucking MASH tent? Her clinic does not even schedule patients using newFNP's schedule template, yet newFNP sees 25+ patients every day she works.  Does that make sense?  If so, someone please drop some knowledge on newFNP because she would love to know.

* The literature about medical homes all use physicians as the team leader.  While newFNP appreciates the importance of physicians in the medical team, she does not believe that physicians need to be the primary care provider with whom patients have a relationship.  NewFNP is not about 'us vs. them' but rather believes that there is room at the table for everyone.  As the old saying goes, there is no "bite me" in teamwork.  Or something like that.


DamselFish said...

Well, on the good side, you have patients who aren't dead and they like you, so clearly you are doing more than something right.


And the schedule thing? Dream on. Easy + Efficiency Enhancing + Logical = NEVER GONNA HAPPEN.

Anonymous said...

i love you. i love your idealismness too. you keep me plugging away at this get into np school thing. but can you explain what a medical house is? thx!

Nurse Practitioners Save Lives said...

I also have patients who will wait for me. I even have a patient who had chest pain at home and refused to go to the hospital unless I said it was okay to go because he trusted me that much. Lord! Don't wait for me, just call the ambulance and go so that you don't keel over...

BostonFNP said...

So, our clinic is getting funding to be a medical home (yes, they have reluctantly agreed to allow the 1200+ patients who consider me their only PCP to continue doing so without the need for a MD to "oversee" their care) and it is turning into an exercise in futility. All the other funded practices are in the 'burbs and have no problem integrating email into their model while we're still figuring out how to get one more phone line specifically for making appointments. But hell, there's grant money a-flowin' and lots of eyes looking at us. If that alone brings some attention to the plight of community health centers, then we've done our job. Hang in there sister... our idealism got us through all those Child Development lectures. It's bound to resurface sometime!