Time at Lifelong Medical Care, Part 2

In yesterday’s post, I talked about my day shadowing with Dr. Pete Lovett, who’s the Medical Director of Berkeley Primary Care, which is part of LifeLong Medical Care. Today, a few more observations based on my time with his other patients, plus my time with Frances Herb, MD, Berkeley Primary Care’s HIV Specialist.

Other patient perspectives

As I mentioned yesterday, I learned that “uninsured” does not mean “uninformed.” Another of Pete’s patients indicated that he was very actively using the Internet to learn more about his condition. He was very interested in complementary healing remedies and satisfied with the results he had achieved so far. As with other patients, there was a challenge here in terms of integrating information from other specialty care providers in the visit. There was not ready access to treatment information. And as with the other patients, this one had a good fund of knowledge about his care in other venues. I asked about this patients’ support system and he indicated that he did share information about his health with a colleague, over the Internet. He also indicated an interest in gaining assistance from his physicians about information he was seeing online about treatment options.

Other connectivity issues

For the rest of my afternoon, I was able to shadow Frances Herb, MD, who is a general internist and specialist in HIV care. I asked Frances what made her decide to practice medicine in this medical center. She told me that she remembers being in the same situation (being uninsured) that many of her patients are in now and wanted to support those that came after her. As with the rest of the Medical Center, charts are primarily on paper. She introduced me to a few of her patients, and noted in each case that she had a written record of their care back 10-13 years. It was an impressive show of continuity.

(side comment: One of the most enjoyable parts of using the paper chart when we had it at Group Health was visiting a member who had been with the organization since 1947 – reviewing their paper chart was like looking at an encapsulated version of the history of medical care. No EHR can duplicate the social experience of paper…)

In HIV care, there is an exception with regard to charting – there is a functional EHR that is interconnected with other medical centers in the area, thanks to Ryan White funding. But only in these patients. As far as I could tell, there is no PHR attached to this record. However, I did see Frances print laboratory values, chart them, and give them to patients – Information Therapy.

At one point I asked Frances how she would feel about securely e-mailing her patients. She said, “Secure e-mail to my patients? I would love to be able to securely e-mail other physicians about my patients’ care.” Good response.

Watching myself

LifeLong Medical Care is the fifth safety net care provider I have visited so far in this project. In true LEAN tradition, I can’t help but reflect (through a process known as hansei) on how I got here. My past experience involved rotation in residency at the Country Doctor Community Health Center in Seattle, Washington, which is not in the Country (it is right around the corner from one of Group Health’s largest medical centers) but does have great doctors. I haven’t been in a safety net medical center since, and I realize that I have lost touch with the disparities in technology that are now existing in modern medical care. This doesn’t mean that I have come to a conclusion that a PHR doesn’t make sense here – just the opposite actually. I can see an even greater benefit here, and maybe more than the EHR itself (or at least as powerful). Now that I have been involved with an ideal care system with the ability to transform, I want to think about ways to support LifeLong Medical Care and organizations like it – I think they are ready and their patients will benefit.

Today, I am going to visit a Kaiser Permanente Medical Center in Oakland, California, a medical center at John Muir Mount Diablo Health System in Walnut Creek, and tomorrow, La Clinica de La Raza, also in Oakland.

Ted Eytan, MD