Many Health Professionals Does It Take To See a Patient in a Primary Care
Two heads are better than one.
Heywood (1497-1580), Proverbs (1546)
Medicine is, or should be, a confidential one-on-one relationship between patient and physician.
A belief of many physicians
It depends on how you define “health professional.”
Do you define a
health professional as the primary care physician?
Then the answer may be one, as Doctor Gordon Moore, a primary care
physician, explained in a 2002 article “
Going Solo: One Doc, One Room, One Year Later, American Academy of Family Medicine, March 2002). In his article, Moore carefully pointed out, it also takes a trusty computer with broad band access to
The answer could still be one, if you accept the premise of doctors practicing “retainer medicine,” aka, direct pay or
concierge, medicine. These physicians
believe in a one-on-one doctor-patient relationship with 24/7 access, patients being seen on the day they call,
longer face-to-face visits, and pay
either at the time of care delivery or on the basis of a monthly or yearly
Then the answer may be
many more if you practice as part of an
integrated team at Kaiser Permanente, as set forth by Doctor David
Lawrence, former chairman and CEO
of Kaiser, in his excellent book, From
Chaos to Care: The Promise of Team-Based Care (Perseus Publishing, 2002).
In his book, Lawrence
listed these members of a team delivering
integrated care to preven manage and treat disease.
Doctor, the leader
Nurse care manager, the glue of the team
Other physicians , e.g, for the patient with
diabetes, a cardiologist, a nephrologist, an ophthalmologist, an endocrinologist,
even a surgeon
Other professionals, - nutritionists,
pharmacists, social workers, health educators, nurse practitioners, physician assistants
Alternative Providers - Chiropractors, Osteopathic physicians, Yoga
and acupuncture specialists, and managers for stress, chronic painl
sports-injuries, and addiction
Doctor Lawrence presents a compelling case that his approach
works better with better outcomes than the traditional one-on-one relationship
of patients to doctors. And it works
better if all of this takes place under one corporate roof with clear
information exchanges between the various team members. His underlying message
is: it’s the system, not the individual doctor or the individual patient who
drive the health care bus.
Health Alliance Team
In a similar vein of health care integration, in yesterday’s Wall Street Journal, Laura Landro,
gives this list of health providers on the health care team with
their duties at Union Square Family Health Center in Somerville, Massachusetts
one of 15 primary care centers of Cambridge
Health Care Alliance affiliated with
Harvard Medical School (“The Team Can
See You Now”, February 18, Wall Street
Journal). The article’s subheading tells
the story, “Why Visit One Doctor When Some Offices Offer a Medical Entourage? Physician Shortage Drives Trend.”
Members and Duties
Landro says team members and their duties include:
Doctor – Supervises medial team, diagnoses patties,
peformsm procedures, prescribes medications.
Social worker – Assists patient with needs like
transportation and financial assistance , connects patient to behavior health services for depression.
Physician Assistant – Handles routine consultations,
manages lab results, point person when doctor
Pharmacist – Advises Patients on how to take drugs correctly and possible side effects and
interactions, adjust dosages, and helps manage chronic pain.
Medical Assistant – Takes patients’ vital signs,
prepares them to see doctor, takes blood for lab tests, tracks follow-up
Registered Nurses – Performs triage and directs some
patient visits like prenatal counseling.
Helps patient adopt healthier life styles.
Team –Based Idea
The idea behind team-based care is to allow team members
to practice at the highest level allowed
by their training and license.
Team-based care is not without dissenters. Many doctors resist it. A majority of patients, according to a study by
a California Blue Shield study, prefer to be seen first and in some cases, only by a
doctor. But 94% of patients
participating in team-based care said they liked it, and 81% said they were
willing to try it.
For larger integrated health
organizations, like Kaiser and Health
Partners in Boston and in many academic centers, team-based care is how medicine is practiced
now. For independent physicians in
private practice, team-care is less desirable, and they prefer other options
relying more on their personal skills and training.
What we are witnessing is the evolution of a
two-tier medical system, with one tier being handled by organizations and the other by personal
practice is evolving into a two tiers – one system consisting of team-based
care, the other of personal physicians practicing independently.
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