Family physicians work to regain patient relations

In a world of medical specialists and quick-care retail clinics, family physicians don't always seem to play a critical role in caring for patients anymore. Now these jack-of-all-trades generalists are fighting to reclaim a place, and their efforts could be good for everyone's health.

The American Academy of Family Physicians is midway through a two-year experiment at 36 practices nationwide aimed at building a more nimble, patient-friendly kind of family medicine. The project, called TransforMED, incorporates flexible scheduling, online consultations, electronic medical records and other technological advances to give patients easy access to comprehensive medical care.

The goal: to build strong relationships with patients and become their "medical home," a place they routinely turn to for preventive care and to manage chronic conditions.

Although the concept has been around for decades, medical homes are getting a lot of attention lately. A June study by the Commonwealth Fund found that 77 percent of men who had a medical home received a prostate cancer screening test in the previous two years, compared with 34 percent of men who didn't have easy access to a regular doctor. Likewise, 79 percent of women with medical homes received mammograms, vs. 49 percent of women who had no regular source of care.

At the same time, the number of medical-school grads choosing family medicine as their specialty has declined by more than half in the last decade, and experts say there are not enough family physicians in the pipeline to meet future needs. Already, long waits for doctors' appointments in some areas have led many patients to use the drop-in retail clinics springing up in pharmacies and grocery stores instead.

"Retail clinics are responding to a market need," says Terry McGeeney, president and CEO of TransforMED. "It's unfortunate that primary care didn't make changes sooner to respond to that need."

Through TransforMED, healthcare providers are trying to make up for lost time. At Family Practice Partners in Murfreesboro, Tennessee, up to a third of the patients physician Susan Andrews sees on any given day made their appointment that very day. Patients with minor medical problems can come in for a "quick sick" visit -- a 5- to 10-minute exam that focuses on just one medical issue.

Someone who wants to avoid visiting the doctor's office altogether can sign up for an "online health call" to deal with relatively straightforward problems like a bladder infection or heartburn. After a patient completes an online medical history that asks for symptom specifics, the doctor reviews it and takes action, perhaps faxing a prescription to the pharmacy or sending out educational materials. "Insurance doesn't cover the $25 cost, but their co-payment is often $25 anyway, and if they don't have to leave work it's worth it for them," says Andrews.

All records are kept electronically, and patients can access the file and look at their chart and ask questions or input health data without coming into the office. This is especially helpful for people with serious medical conditions, says Andrews, where careful monitoring can help keep them out of the hospital.

After a virus destroyed much of David Wilson's heart muscle about six years ago, the 50-year-old developed congestive heart failure and now has to keep close tabs on his vital signs. Every day, he goes online and types in his weight, blood pressure, and heart rate. Andrews reviews them and touches base as necessary. Recently, she sent an e-mail suggesting Wilson reduce the dosage of one medication slightly. "She can know what's going on instantaneously," says Wilson. "That's really comforting."

Unfortunately, doctors often don't get paid by insurers unless they see patients face to face. McGeeney says TransforMED is working with insurers and employers to find ways to pay physicians for some remote patient care. "The reality is some things are pretty standard and the physician's probably not going to give you a full physical anyway," he says. "Reimbursing for an electronic visit is a win-win."