The excellent issue of Health Affairs issue on reinventing primary care is out and I wanted to point people to this article about medical assistants, yes medical assistants.
First, a disclosure – I have been a fan of the UNITE Health Center ever since I visited it in Feburary, 2008 (photos and blog post are here), because it is one of several practices that is innovating as much as any of the well known large practices in the United States. Actually, there are many many more innovations happening in practices like this than people think, and as I have mentioned on here tons of times, they are all willing to teach, all we have to do is ask.
The article discusses the inclusion and involvement of medical assistants in the improvement of primary care. One key component of this groups thinking caught my eye:
UNITE Health Center decided to transfer most of the responsibility for patient teaching to its patient care assistants, who are hired with medi- cal assistant credentials. The hope was that these assistants, who typically share the patients’ cultural backgrounds, would foster a level of comfort and trust that would enable them to teach patients how to manage their chronic diseases, at a much lower cost than using registered nurses or certified diabetes educators.
It immediately triggered the memory of me sitting in the same room photographed in the article, with the primary care team, and one of the team members describing to me her own family’s experience with UNITE Health Care Center before it became what it is today. She talked about how her family would block off an entire day from their calendars to see a doctor, and contrasted it to the work of UNITE in it’s new incarnation, where patients and families were afforded the same access (and dignity, really) as patients in the most well-funded health care systems. That’s experience that’s worth bringing to the improvement of primary care – it’s really foolish not to.
As the article describes, the physicians who work here are trained to involve all members of the team caring for patients, and in turn, all members of the team receive the investment of comprehensive training so they can perform well for their patients. I learned here that medical assistants are as interested as physicians in performing well for patients.
In the era of social media, where we understand more than ever that people trust people “just like me,” look at one of the impacts of the investment:
The need for a substantial presence of patient care assistant staff has also allowed the health center to hire from its communities. The center has thus been able to institutionalize the strong relationships and shared backgrounds between patients and caregivers that are so important to the success of this model.
And…the clinical outcomes and costs favorably follow from this approach. It’s worth noting that the patients in this practice are among the least advantaged in society, and yet, their time is as valued as if they are the most advantaged, with great results. Virtuous circle.
If I were to generalize the findings here with my own experience, I would say that the most productive, enjoyable, and health-promoting primary care practices I have seen are the ones that make the investment in the entire team. An investment in the patient as part of the team typically is not far behind.
Thanks again to the medical assistants. And to Karen Nelson, MD, Jonathan Arend, MD, and the UNITE Health Care staff and patients for demonstrating that primary care is not meant to be going to be a row of blinking lights in a clinic hallway.