For the last 18 years, I have been privileged to work with parents and families in and around Webster MA to create a medical home for children, regardless of the ability of their parents to pay for care. What does that mean? For us, it meant understanding the needs of the communities that we serve, remaining focused on an ideal that is not fostered by our current systems of care and engaging in partnerships with parents, families, community agencies and always with the children. Our goal has been and continues to be to help our children to grow up healthy and that health is more than the absence of disease: emotional and developmental health is as important as physical and dental health. We have aggressively pursued that goal over the years, by engaging with parents in the office, on the telephone, in the schools and even sometimes in their homes. We have created teams and coordinated care, assuring that all those caring for a particular child are in communication with each other. We have started programs: adolescent clinics, Reach Out and Read programs, car seat loan programs, walking groups and school health programs. We have cared for more than 10,000 children and adolescents over my tenure in the practice, and we have helped many through some very difficult times. We want to be able to keep doing this good work. Health reform is an opportunity to address many of the barriers that we have encountered in our struggle to provide a medical home in South Worcester County Massachusetts. Here are a few things that we should do:
- The system should emphasize primary and secondary prevention, and that needs to be reflected in the way physicians are paid. Well care, immunizations, developmental screening, preventive mental health care, dental care and prophylaxis all need to be covered services, and the conditions that we find in our screening need to be addressed through treatment.
- The system should encourage for coordination of care, whether through the payment of non-physician staff to coordinate care or incentives to establish electronic links among the referral teams.
- The system should not intimidate parents who are seeking care, at the front desk, in the exam room, on the telephone or in the room with a physician. Parents have too much as stake to be forced to deal with an inpenetrable system.
- The system should understand that parents need different things than do adults: time and reassurance on the phone, understanding of perception of pain, a EMR that can take the contact information for divorced parents.
I've been blogging about these sorts of issues for the post 2 years. It will not be easy to build this new system. But we can do it. Yes we can.