“Medical students should be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on systems resources to provide care that is of optimal value.”
– Joint Principles for Medical Education of Physicians as Preparation for Practice in a Patient-Centered Medical Home
American Academy of Family Physicians
American Academy of Pediatrics
American College of Physicians
American Osteopathic Association
I’ll admit it – the health policy nerd heart in me leapt a little bit in reading these lines. *Learning about the economics of the health care systems, how to coordinate care with other service providers to provide optimal care, advocate for patients on a holistic level, understand and use evidence-based practices, and integrate electronic medical records and electronic means of communicating with our patients? **Heck yes! ***
Read the document for yourself, fellow medical students and educators, and see if you don’t find yourself wanting to learn more and/or engage in more in-depth discussions in these issues. They are the bread and butter, passion and soul of wanting to provide better patient care in our increasingly complex, multi-faceted health care system.
And yet, reading it, I could not help but pause and wonder – aren’t we getting a little ahead of ourselves?
**1) **Who says that any of us, after graduation, when we finally, truly have our own practice, will be going into the Patient-Centered Medical Home model? The interest in primary care is plummeting with less than 2% of medical students choosing primary care [Edit: as @mdstudent31 points out in comments, this figure is an underestimation from internal medicine residents only. If we count family med and peds residents, the number is probably closer to 20% and seems to fluctuate year by year]. From the patient end, I can’t find any precise numbers, but it seems that I am not the only young, healthy college student who has had a terrible time finding a doctor at all. And I will thoroughly admit that right now, at the beginning of medical school with years of residency ahead of me, work as an actual doctor still seems incredibly remote. Who knows what health care will look like then?
However, I’ll acknowledge, that this objection is mostly out of my own cynicism. Education must always be forward-thinking. We should be making a more continuity-based and primary-care-focused curriculum, so that we can encourage more students to pursue or at the very least respect primary care and seek patient-centered systems to work for in the future.
**2) ****What is the use of learning all this if there is little that we can do with the information that we are given? **I tend to keep myself fairly well informed on care coordination, from following research studies of breakdowns in primary care to specialist referrals to avidly reading the latest Atul Gawande article on how coordination of care is particularly important for our healthcare system’s highest spenders. And because I happen to be passionate about these issues, my thought after reading these articles is always – how can I get involved? Where can I find a research project in this area or a doctor to shadow to learn these techniques?
Unfortunately, the answer, more often than not, even in the resource-rich setting where I live at the word-class university where I learn, is: wait and see. Wait for the health services department to come around to studying this issue, wait to see whether the local network of community clinics is going to implement the patient-centered medical home model, wait for when I am finally done with my basic science and regular rotation requirements so that I can do a rotation at one of these chronic care homes that do embrace the model of patient-centered coordination of care.
Maybe I am biased by my current set of contingencies that is making the pursuit of this particular passion feel a little bit like banging my head against a wall. But somehow, I doubt I’m the only medical student that feels this way.