Caring for a population ... one patient at a time

Something about population-based care seems inconsistent with family medicine, at least on the surface. If you wanted to improve the health of populations, you would have gone into public health, right? Surely most family physicians are attracted to the specialty by the prospect of caring for patients -- by the prospect of meaningful, long-term relationships with patients as individuals, not the satisfaction of keeping faceless throngs happy.

I was reminded of this by a recent comment on one of my blog entries. Kin Snyder, MD, asked, "What happens to the individual patient in a population-based care scenario? Patients will still want to see ‘my doctor’ when things are going bad for them. They don't want to be known as registry # XXX." Indeed. Nor do family physicians want to spend their lives taking care of registry numbers.

I think this image of population-based care may sell it short, however. Used properly and wisely, it doesn’t turn patients into registry entries; it turns them into healthier patients. The trick is to manage populations and care for individuals.

The locus of care is the exam room, the bedside or the delivery room; that’s where patients are cared for and doctor-patient relationships are built. The trouble is that this caring and relationship-building proceeds one patient at a time, while 1,500 or 2,000 or 3,000 patients think of you as their doctor.

True, the main goal of population-based care may be to increase the percentage of that population who have the interventions they need, but in the process, it helps you keep in touch with them. If having a diabetes registry, for instance, helps you and your staff to get Harry Smith in for his follow-up appointment more regularly, it doesn’t make Harry into registry #XXX; it puts you and Harry together in the exam room when otherwise you might not see him from one year’s end to the next. What’s wrong with that?

Posted at 03:42PM Dec 10, 2008 by Bob Edsall  |  Comments[1]