By this point in January we are all wearing our Fitbits and logging our every mouthful into Lose It!, but beyond our own quantified self, what resolutions have we made to be better e-patient advocates?  I propose and have made the following 3 resolutions and ask that you join with me or share with me your own.

In 2012 I resolve to:

1. Courageously and persistently share my e-patient advocacy with my own care team and institution to support (i.e. insist upon) their adoption of new technology and the workflow changes necessary to partner with engaged patients.  (The e-patient version of think global, act local.)
2.  Improve my research literacy (more in next week’s post) – my facility with the terminology, methodologies, and mathematics required to converse with the scientific community and interpret medical information.
3.   Schedule time to proactively mentor other emerging e-patients (as well as spend time with my e-patient mentors).  Congratulations to all on the Top 10 Healthcare Influencers to Follow List.

Here’s to you being not only more active in 2012, but more actively engaged!

Think of Joining the Society for Participatory Medicine. @S4PM

Two recent speaking engagements provided me the opportunity to think deeply about the discharge process, an area of healthcare delivery rampant with errors and missed opportunities to support sustained healing and health for patients. This is an area of keen interest to me as I have experienced the discharge/transition process 16 times ( I may have lost count in there somewhere) as a patient and twice as a caregiver to spouse and parent.

On October 20^th I delivered Grand Rounds at Montgomery General Hospital. My topic was Patients as Partners in Quality Care Improvement.

On October 13^th I had the privilege of being the patient speaker at an event focused on identifying opportunities for technology to improve the transition of patients from acute care settings to home or a rehabilitation or long term care facility.  “Putting the IT in TransITions” was convened by the Office of the National Coordinator for HIT as well as the John A. Hartford Foundation and the Gordon and Betty Moore Foundation in Washington, DC at the Kaiser Permanente Center for Total Health.

The three questions posed were:

1. What are the most important problem statements from the patient’s and caregiver’s perspective that require our attention?

2. Where is IT effectively addressing these challenges now?

3. Where is innovation most needed now?

The invited attendees participated in breakout sessions to brainstorm on the four particular areas of transition:

1. Discharge process

2. Medication reconciliation

3. Information flow and feedback

4. Patient and care-giver activation

Below are some of the key points from my presentation.  The entire webcast can be seen at http://www.visualwebcaster.com/event.asp?id=82572.  (I start at minute 42)

Successful discharge begins at or before admission.

Reducing readmission is based on addressing the totality of the circumstances that a patient encounters when they leave the hospital.

Opportunity 1: Accurate electronic transmission and appropriate exchange of a patient’s medical history, including known allergies and other alerts can aid and speed diagnosis, avoid unnecessary tests and scans, avoid repeating failed treatments, and laser focus on will work. [Tech Op:  Portable Patient Health Record]

Opportunity 2: Sharing information, including lab values, with patients and caregivers in real time creates trust, and leverages the ability of patients and families to spot errors and omissions.  An EMR is only as good as the information is used. [Tech Op:  EMR]

Opportunity 3: Coordinating, accelerating the integration and conflict resolution of information across specialists is an essential HIT function that power to truly impact care and bend the cost curve in the management of complex patients.  As a liver transplant recipient for underlying autoimmune conditions that manifest in GI and other areas I need to get sign off from all groups before discharge.  This has often taken a full days worth of nurse-hours to procure. [Tech Op: EMR]

Opportunity 4: Beginning the education process – nutrition, self-care, new medication regimens – long before the discharge day would provide an opportunity for patients to begin formulating questions for medical staff in a more timely fashion and start the process of strategizing how to adhere. [Tech Op: Ipads loaded with videos, links to Medline, patient disease state communities]

Opportunity 5: Customized, tailored discharge plans can be populated and continuously updated throughout the hospital stay, triggering communications to long term stay or rehabilitation facilities for certain conditions, orders for medications, equipment, even groceries that meet a prescribed dietary change.  Everything a patient needs to do or have for the immediate post-discharge period needs to be ordered, arranged, scheduled and delivered before they leave the hospital. No exceptions.  Patients are sick, tired, happy to finally be home.  Caregivers and sick, tired, happy to finally be home.  They may not be able to leave the patient to run between pharmacy, grocery store, medical supply once they get home.  Follow up calls to physicians and often not made in the return to home life.  Let’s say good bye to the scribbled sheet of paper with vague generic instructions hastily put together in the final hours of a stay.  [Tech Op: E-prescribing, Peapod/Safeway grocery delivery, RHIE to link to appt scheduling]

Opportunity 6:  Provide resources to fill in the gaps for tasks the patient or caregiver would normally have to do at home instead of resting and healing.  A list of or links to childcare, respite care, lawn service, short- term concierge services, would both give permission to rest and help locate appropriate assistance.  Tools to help patient families organize their own communities for support would also be helpful.  There is a lot left on patient family shoulders even for those who have visiting nurses and other clinical support. [Tech Op:  Foursquare, Groupon, Caring Bridge]

None of these scenarios require anything more than technology we have available today. The reality is that transformation of the discharge/transition process will take a combination of change in workflow and culture in addition to technology.

If you are patient/caregiver who has used a technological solution to help with a care transition or a vendor who has or is working on a solution addressing one of these opportunities, please comment and let us all know.

As a dutiful patient, one week prior to my doctor’s appointment I got my requisite blood tests done.   I use Lab Corp instead of going to the hospital lab because I can make convenient appointments online, get email confirmations, and quick access to the results.   In a surprising turn of events I actually received a call from my doctor’s office with the results 3 days later.  I say surprising because normally I have to beg, plead, call, or at least charm a nurse to get my results at all.  The caller announced that the results were “fine”.  Now in 27 years with a chronic disease “fine” is not a word I usually heard in conjunction with my bloodwork, so I asked if I could see them.  (note: every patient should do this)  “OK” was the quick answer.  I could fax or email them to you.  Yee Haw!! Now we were getting somewhere.  Of course there were abnormal results and some tests that should have been conducted that were not  (one way to get “fine” results is apparently to omit tests I don’t do well on), but the liver enzymes were solid.  So, fine.  We discussed the other issues when I got to my appointment.   But let’s not miss the point here people, the big cultural shift, the message received, at least this one institution – I had the right to see my blood test results.

To ensure that all patients, not just the lucky few with enlightened physicians have this crucial information, last week at the launch of the HHS/ONC Consumer Engagement in HIT campaign a proposed rule was announced to allow patients direct access to their results from the lab.  This is an enormous step forward in the annals of patient engagement and participatory medicine.  Please submit comments to make sure that this rule passes at  www.regulations.gov  or by following the directions in the Federal Register Announcement.

HHS Proposed Rule Allowing Direct Access to Lab Results http://www.ofr.gov/%28X%281%29S%28cp53mc3sjd3cbdfu4r32fhcj%29%29/OFRUpload/OFRData/2011-23525_PI.pdf

Center for Democracy & Technology http://cdt.org/blogs/harley-geiger/139under-proposed-rule-patients-will-receive-clinical-test-results-directly

I have spent the past two rainy days with senior executives from the Adventist Healthcare System and a range of integrative medicine and community leaders as part of an effort called Next Century Health. Next Century Health is a visionary initiative of the Adventist Healthcare System, a  large integrated  network of hospitals, rehab facilities, home health, and other health services, to respond to the key trends and drivers transforming healthcare today in something more than a pro forma fashion.  I, along with such notables as former HHS Secretary Dr. Louis Sullivan, former FDA Commissioner Dr. David Kessler, and former Senator Dr. Bill Frist, are committed members of the Next Century Health Leadership Council.  Below are 5 reasons I think that Next Century Health may actually achieve its ambitious goal of advancing whole-person health and healing across the greater community.

1. It’s in their culture.  The Adventist HealthCare System has its roots in the Battlecreek, Michigan  health resort of Kellogg’s corn flakes fame.  It flourished with a focus on connected mind, body, and spirit for healing purposes.  Discussions of whole-person health and well-being are authentically part of their DNA as an organization.
2. They have a track record.  The five-year and counting Center for Health Disparities established by Adventist is a create model of addressing tough issues, working with community leaders, and keeping long-term commitments.
3. Vision before bricks and mortar. The system has several large-scale building projects in the works, including a massive White Oak Campus adjacent to the FDA.  Integrating elements into every building and campus expansion plan that actively promote fitness, restoration, and connection from the start rather than as an afterthought greatly increases their chances of adoption and execution.
4. Partnership, Structure, and Sustainability.  The two days of discussion included very tactical and tangible planning for the best partnerships, structures, communication loops, and policies to sustain the effort for decades.  This could have been so easily just a PR opportunity, but the time commitment of the hospital and system presidents to a multi-hour roll-up-your-sleeves  brainstorming and options weighing lent a great deal of credibility.
5. Stewardship.  The second day of the Next Century Health meeting was a forum on Whole Person Health, Scientific Advancements & Ending Obesity with panelists including former AARP CEO Bill Novelli and Partnership for a Healthier America CEO Larry Soler.  A robust conversation on the root causes and potential solutions  (active, passive, and sanction-based) for the obesity crisis was held for several hours, but what impacted me most was the last comment of the morning, made by Dr. Alan Handysides, Director of the Department of Health Ministries, and a member of the Next Century Health Leadership Council, that core to the Adventist approach is the belief that stewardship of health has value.  From roots that strong a mighty tree can grow.

Learn more about Next Century Health at http://www.nextcenturyhealth.org/

In my estimation, the FDA does the best job of any federal agency of effectively supporting and leveraging empowered patients in meaningful ways.

Here is a great example:
If you are interested in learning more about how the FDA develops and regulates drugs and meet the actual people involved please consider registering for this Patient Network Conference. Registration is free!

Dear Patient Advocacy Community,

The Food and Drug Administration’s Office of Special Health Issues is sponsoring a Patient Network Conference that will take place on Friday, July 15th, 2011, from 8:00 a.m. to 5:00 p.m. at the FDA Campus at White Oak. The address for the FDA Campus is 10903 New Hampshire Avenue, Building 31 Great Room, Silver Spring, MD, 20993.

This conference will include sessions addressing a variety of topics for the oncology patient advocacy community including drug, biologic, and device development and regulatory processes as well as interactive sessions with management from the Office of Oncology Drug Products in the Center for Drug Evaluation and Research. Attached is a draft agenda.

Seating for the conference will be limited to the first 150 persons. The conference will also be available via live webcast. The web link for this will be provided closer to the conference date.

To register for the conference, please send an email to: PatientNetworkConferenceatfda.hhs.gov with the following information:

First Name:
Last Name:
Organization:
Preferred Attendance: In Person or Webinar
Current Role:
- FDA Patient Representative
- Patient Advocacy Group
- Patient / Survivor
- Other

For directions, parking, and local lodging information, please refer to the following website:
http://www.fda.gov/AboutFDA/WorkingatFDA/BuildingsandFacilities/WhiteOakCampusInformation/ucm241740.htm

Best Regards,
FDA Patient Network Conference Team

The remarks below are a distillation of my presentation at the April 14, 2011 Patients as Partners in Care: Engaging Patients through Health IT event at the National Press Club hosted by RTI International. I was privileged to share the panel with Dr. Edward Glynn, Ambulatory Medical Director of Informatics, Bon Secours Health System; Lygeia Ricciardi, the 1st senior advisor for Consumer e-health, Office of the National Coordinator, Health & Human Services; Ann Bartlett, a patient and brilliant diabetes blogger for Health Central; Drs. Jonathan Wald and Douglas Kamerow, both of RTI International.

Thank yous to @CindyThroop now at RTI for the invitation, @ReginaHolliday for her real-time artistry, and @HITgreg from Clinovations for live-tweeting these concepts.

Myth One: “Potato/Patato”
The most fundamental myth when discussing patient engagement is assuming that patients and consumers are interchangeable when asking the question what a segment of the population wants from HIT. As I described in a previous post Consumers vs. Patients, the needs, preferences, and intensity varies with frequency of interaction with the healthcare system among other factors. Allow me to use the following analogy. What do you want from a camera? If you are Annie Lebovitz you’ll make a very detailed request involving aperture, shutter speed, lens exchangability, etc. If you ask me, a person who takes perhaps 5 photos a year that never seem to make it out of my computer, I would say that any old thing would do or really not contribute much to the discussion. Likewise, the input from experienced patients, those with chronic diseases whose lives depend on accurate, complete and timely exchange of data between and with their healthcare providers is an entirely different from the input of feedback of consumers or people with more limited needs. You only need an HIT solution if you have a problem.

Myth Two: “If we build it they will come”
Most HIT vendors have a field of dreams mentality, “If we build it they will come”; making no attempt at patient engagement in the design of HIT systems, or mistakenly trying to get input on technical aspects rather than end user experience and functionality goals.  Vendors and health system purchasers are now either frustrated with patients for not fully utilizing the available portals or tools, or are scrambling to start consumer engagement initiatives, usually again without having patients involved in designing the initiatives.  Meaningful engagement leads to meaningful use.

Myth Three: “Just say no”
A very pervasive myth is that patients are only concerned about data privacy and are opposed to sharing of data. The consequence of this erroneous assumption is that patients are not afforded the rights to manage their data and affirmatively select their privacy options, for fear that the population health, research and other benefits of using aggregated deidentified data will be lost. Two points – (1) patient care about many things other than privacy, and different patients have difference privacy preferences. Patients also care about accuracy, convenience, interoperability, safety, efficiency, priority and quality. (See What Patients Want from HIT). (2) It astounds me that there has not been any large scale educational campaign to the public or through patient advocacy organizations to educate on the potential and promise of HIT are, so that when patients are confronted with the choice to share information, they understand the implications.

Myth Four: “Look but don’t touch”
I applaud those institutions  that have set up a patient portal or otherwise allowed patients access to view their EMR either in whole or in part. However, as any patient who has looked at their records can tell you there are often inaccuracies, gaps, or redundancies that make the record misleading or downright dangerous. Additionally there is a wealth of patient generated data from mobile apps, diagnostic devices, and old-fashioned patient self-management notes that can potential inform care that never enters the formal EMR. It seems to me that that position that provider controlled EMRs with no mechanism for patients to enter or alter data are the only way to maintain data integrity misses a huge opportunity to harness patients as partners in correcting information and ensuring that all relevant information is in fact captured.

Myth Five: “It’s not for you”
Just as the whole notion of e-patient activism has come under fire for being the domain of only an elite segment of tech-savvy individuals, many claim that HIT does not serve low income or minority populations. Organizations such as the National Health IT Collaborative for the Underserved, One Economy and other are making sure that the digital divide does not carry over into the health arena. Moreover, capitalizing on technology like cellphones, already enjoying a high penetration in communities, health campaigns like Text4Baby are proving highly successful. Early data from a Morehouse School of Medicine study E-Healthy Strides Application© for Interactive consumer driven diabetes self-management sponsored by the Microsoft ™ Be Well Initiative demonstrate an opportunity to successfully overcome barriers to HIT use among African American patients.

What other misplaced or misleading assumptions do YOU think are frequently made about patients’ views and potential for engagement with HIT?

This post was 1st featured on the Disruptive Women in Health Care blog and will be part of an upcoming e-book on Innovation.

There are countless articles and books on innovation – incremental innovation, radical innovation, disruptive innovation.   However, I would argue that, with a nod to the authors of Blue Ocean Strategy, that unless innovation is value innovation, providing some deliberate and distinguished combination of factors or service to improve the experience or effectiveness for relevant stakeholders while reducing costs it is not innovation at all, but simply something new.

That said, the case for personalized medicine as a value innovation, a valuable innovation, is one I am eager to make. The most common definition of personalized medicine is genomic-based risk assessment, diagnosis, treatment.  Personalized medicine broadly construed also comprises technology-supported medical practice able to aggregate data on a population level to a degree that positive or adverse outcomes can be spotted in sub-populations of patients, and patient-centered medical practice that provides care in the context of an individual’s culture, values, and health literacy levels.  The uniting concept is a healthcare framework that gets the right treatment for the right patient at the right time, creating a safer, more effective, more cost-efficient healthcare system.  Think of personalized medicine as producing Me drugs rather than Me-too drugs.

The value of personalized medicine is best perceived using a systems view of cost and experience across identification, diagnosis, and treatment of a disease.  Imagine oncology today without personalized medicine.  A woman would not know at a young age that she has a genetic predisposition to a cancer, despite no family history that would raise no red flags. She and her physician do not start an early or aggressive schedule of mammography or other screening. A lump in her early 30s is dismissed. When she does develop cancer, there is no way of determining what type of specific cancer, she is given a treatment that she does not respond to, other treatments are attempted, but ultimately she dies.  The cost of her care is needlessly expensive and the clinical outcome is tragic.

The reason that that does not happen today, at least for certain cancers and other conditions is that a financial and regulatory system supported the development and access to early personalized medicine products. The greatest threat to continued value innovation in personalized medicine is lack of a coherent financial and regulatory framework that recognizes the value of the genomic-based diagnostics and therapies and reimburses appropriately.

A personal example – as a liver transplant I have blood analysis done several times a year to review my liver enzymes, levels of medication, and other markers. Recently, my physician and I have added a test called Immuknow® that provides an assessment of my immune system’s individualized response to the immunosuppressive medications prescribed.    This test gave unique information that despite my dosage, my immune system was still very active putting me at possible risk for rejection of my organ.  Where traditional tests would have led to reduction of my immunosuppression given my apparent stability using traditional tests, the personalized test compelled a different treatment decision. Without this test it was likely that, as in the past, I (and my insurance company) would have incurred tens of thousands of dollars for liver biopsy; greatly increased dosages and numbers of medications usually delivered by IV not orally; hospitalization; and in extreme but foreseeable possibility, rejection or retransplantation which would put the figure then in the hundreds of thousands.  Avoidable for about $600.

Immuknow® is FDA-cleared to be conducted in a complex manner to produce clinically valid results, yet current CMS determinations under the constraints of the laboratory fee schedule processes of cross walks, gap fills, or code-stacking, basically attempts to match new technology to old payment systems, have resulted in a level of reimbursement that does not even cover the costs of performing the test correctly, let alone reflecting its value.  The likely consequence is that hospitals will stop performing the test in an environment where they lose money each time they perform it, and patients and physicians will lose access to this test and the important clinical decision support it provides.

The Bible warns against pouring new wine into old wineskins as unworkable.  Our current system for determining the reimbursement for personalized therapies is just as unsustainable.

Resource: The Personalized Medicine Coalition

I am privileged to have been invited to speak at two conferences this week to lend the patient perspective to panels on the future of health information technology. Kudos to each meeting planner and moderator who prevailed upon their colleagues to include a patient as an active participant in the thoughtleadership and agenda setting that occurs during these meetings, shaping the perspective of attendees across stakeholder segments and planting the seeds of what will bloom into policy and regulation in public and private sectors.

In preparation, I’d love to share my initial thoughts with you, Dear Reader, and ask for your suggestions for my remarks.

I see the essential question as: What do patients want from HIT? (EMRs, EHRs, PHRs)

My answer has seven principles:

1. Comprehensiveness

2. Accuracy

3. Priority

4. Safety

5. Efficiency

6. Privacy

7. Quality

Comprehensiveness: An electronic medical record should aggregate all my information across time, specialties, and institutions/practices. A record that does not hold my historical records from all my doctors no matter where I was treated can be misleading to the point of peril.

Accuracy: The information must be correct to be useful. And please make sure my record only holds conditions, lab results, notes, and images that actually belong to me.

Priority: My ideal EMR would highlight the important information in my record for my physician, organizing and alerting her to key issues, new results, missing information. Simply distinguishing between conditions successfully treated in the past from ongoing conditions would be a step up from some current offerings.

Safety: I was thrilled to see the new barcode scanners at my local hospital reducing potential medical errors by checking patient identification bracelets against each medication before administration. Checking for drug interactions, allergies, avoiding overdosing are all important abilities for HIT solutions.

Efficiency: I could spend all night listing ways that the average physician office can be less disorganized. Tops on my wish list are the functionality to send lab results, e-prescribe, schedule appointments, send reminders, instructions for procedures, and orders for bloodwork.  I’m sure many of you would have guessed that my most pressing desire would be to be able to contact my doctor by email. While that would be nice, I am so much more interested in my doctors emailing and coordinating my care with each other before they get around to talking with me.

Privacy: There is a spectrum of comfort level with sharing and release of even seemingly innocuous personal health information. In general I believe that most patients would like to have systems that facilitate appropriate sharing of information for purposes of treatment, more individual or consented release of information (even deidentified) for research purposes, and are concerned about discrimination in employment and other settings if information is made public.

Quality: HIT contributions to quality are predicated on everything listed above. One additional significant way that EMRs  can improve quality of healthcare delivered is to accelerate the translation of new science, guidelines, or regulatory information to healthcare practitioners.

As a patient, a decidedly non-techie patient, unless you involve me throughout development of health information systems and keep a laser focus on the practicalities of care and research your vast expenditures of time and resources may all be for naught. You can build it, but I may not come. Thanks for finally asking what is meaningful use to me.

The 6^th Annual World Healthcare Innovation and Technology Congress

http://worldcongress.com/events/HL10010/index.cfm?confCode=HL10010

Preconference to the American Academy of Nursing’s 37th Annual Meeting and Conference Transforming Nursing through Informatics and technology: Implications for Practice, Education & Policy.

http://www.aannet.org/files/Onsite_Program_2010.pdf

Although often use interchangeably, there are distinctive differences between consumers and patients in the context of healthcare.  Much is made of what to call those of us actively engaged in pursuing and receiving medical care from health professionals and this post does not intend to settle that issue, but after reviewing countless new conferences, pieces of legislation or regulation, coalitions, job titles, and  grant opportunities,  I’ve discerned a shift towards using consumers as the catch-all term to describe what are actually segments with different experiences, needs, views, and behaviors within the healthcare system.  Too often I see the few seats at the table begrudgingly opened to non-physician or non-academician or non-corporate  parties are filled by labor unions, general consumer groups, and organizations whose average members may not have visited a doctor in years. Organizers, though, feel satisfied in checking off the patient representation box.

Consumers, in my personal dictionary, are members of the general public. Consumers may be perfectly healthy (or think they are) with little contact, or desire to be in contact with the medical system.  The term consumer is also associated with rational nonurgent cost and feature comparison activities demonstrated in other industries with more transparent information sharing.

Patients, acute patients for the purposes of this post, are people with some illness or injury necessitating an interaction with the healthcare system.  They are not electively consuming goods or resources, but trying to secure the more effective treatment with the least amount of pain, time, and cost (if there is a choice or information). Their experience with clinical settings and information may be short-lived and soon forgotten.  If there was no error or incidence involved patients may return to their lives without having been significantly shaped or changed.

Patient Warriors, those patients with chronic diseases, diseases that are potentially terminal or that leave life-changing and to whatever degree life-defining marks (visible or invisible), offer something fundamentally different to the conversation.  Experience over 2 decades with 3 conditions at 4 institutions with 5(to the nth power) physicians, nurses, fellows, medical students, and techs is quantitatively and qualitatively richer than that of an acute patient or a consumer.  Their cost calculations are too often, should I buy food or medicine? should I bankrupt my family or save my life? should I pay these medical bills or my mortgage?

There is a great need from a population health perspective to reach all three segments but the approaches and expectations of each should be varied.  Moreover, than cannot be substituted for one another for research, policymaking, or other purposes.

Consider these questions:

Do consumers want access to their personal health records?

What role do patients want to play as part of their healthcare team?

Can patients be experts?

What is the consumer perspective on comparative effectiveness research?

These questions are almost meaningless as asked.  Consumers may not care one whit about access to a personal health record, but it may mean life and death to a patient warrior.  Patients (subject to individual preference and temperament) may want to be informed while a Patient Warrior may want to be perceived as a full partner or have endured for so long they just want the key decisions while they maintain a positive mindset.  Patients may not be interested in becoming an expert. Patient warriors (often E-patients) may spend hundreds or thousands of hours reading, attending medical conferences, questioning other patients and physicians.  Consumers may consider comparative effectiveness research as commonsensical as having Consumer Reports for other products and look forward to cost-savings.  A patient or patient warrior may be skeptical that a personalized treatment option may be made inaccessible to them.

Extent of interaction with the healthcare system and impact of health issues on someone’s life are the defining factors in determining these population segments.  If we really are to solve the myriad of challenges affecting healthcare we can’t afford to be lazy in our language or our thinking about ensuring that all stakeholders are truly considered and engaged appropriately.

I finally did it. Today I made the plunge and signed up for MDVIP, a so-called concierge or boutique medical practice. What drove me to that decision? Several factors. Becoming a more empowered patient, a more informed patient, I grew increasingly aware of the promise and potential of medicine practiced in a patient-centered fashion. Also, as a busy person the time spent in doctors’ offices and the time I was spending tracking down results and coordinating my care was more than I felt I should have to give to the process. When I went to schedule my last primary care visit and was given a date 3 months away I cracked. Straw meet camel’s back.

Now I can’t go without a primary care physician and with my cavalcade of conditions not just anyone would do. What were my choices? (1) Find another primary care physician who wasn’t, like my PCP, overbooked with patients and undersupported by technology; (2) Pay $2000 for an Executive Health Screening (at the same academic medical center no less) that offered convenient scheduling of a full day of all the tests and examinations I needed but still left me without a longterm relationship with a primary care physician; or (3) sign up with an MDVIP physician who, due to a strategically limited caseload of patients at $1500 a pop could offer the holy grail of true access. Access to a timely appointment, access to the doctor without waiting hours, access by email, and by phone in a timely matter, access to my health records and lab records.

Some may criticize me joining such a practice, akin to putting my kids in private school if I live in a bad school district instead of becoming head of the PTA. As the daughter of schoolteachers who gave a combined 72 years to improving education for others’ children while sending me to the best option for my growth, I say one can support the system of tomorrow without sacrificing to what it is today.

Many more criticize doctors who set up MDVIP practices. If you google MDVIP, a for-profit company based in Florida, as I did, you will find a host of links referring to MDVIP as a scam, a rip-off, for greedy doctors abandoning patients, etc. I say to my fellow patients — Stand down! Take a breath and think about it. Your doctor went to college, medical school, residency, fellowships to learn everything needed to treat you excellently. Unless their families were independently wealthy, they accrued large debt, and now you want them to save your life for the same amount of money that you pay your teenage babysitter. Come on be fair. You say, “but my doctor gives me lots of attention. Why should I pay extra for what I already am or what I should be getting?” Well then you are why the rest of us wait 2 hours. And your doctor is on his or her way to being a burnt out shell who will leave the profession in a few years. The first thing out of the doctor’s mouth when I went to visit the MDVIP practice was, “Under my former practice model I was pressured to spend increasingly less time with patients who had increasingly more problems. I couldn’t do for them what they and I both wanted to be able to do.” Sounds like just the type of doctor we all want.

The only real solution is more primary care physicians. Fully paid tuition, better reimbursement for preventive and coordinating services, and other supports for those who go into and stay in primary care would be one of the best investments this country could make to ensure true access to quality healthcare for all.

Primary Care Evaulation Chart MDVIP vs. Executive Health vs. PCP