Why We Need a Patient Centered Medical Home

Sometimes, I have an encounter in practice that reminds me of why we need a patient centered medical home. I want to share a recent encounter with you that demonstrates the need and why I feel so passionate about what I do.

Ms X. came in to see me after a five year absence. She had been seeing me previously for her high blood pressure and osteoarthritis. We had been making some headway on her obesity and then I lost track of her. Turns out, that she lost her job and went without health insurance. To help save money, she sought care at a local community health center. They did a good job managing her hypertension and arthritis, but neglected, for a variety of reasons, issues of preventive care.

When she came back to see me, she now was insured with Medicare. She wanted a mammogram, but didn't let me know until I was getting ready to exam her that she had found a mass in her breast "a while ago." Sure enough, on exam I felt a mass that concerned me and within a week the diagnosis of metastatic breast cancer came to my desk.

I can't say that she wouldn't have had that diagnosis if she had continued her care with me. But, I wonder if having mammograms on an annual basis (which our system tries to insure) would have caught it earlier? Or, would having a relationship with a regular provider have allowed her to come in for an exam earlier? I don't have an answer, but it makes me think...

What do you think? Do you have similar stories? Let me know...and let's continue to work towards a family physician (and a patient centered medical home) for every American.