The Doctor Is In

The ideas, alone, horrified Group Health family doctor Harry
Shriver when he first heard them: Answer his own phone—without a nurse
screening calls first? Give patients his e-mail address?

But these changes were part of a new experiment in health
care that is now gaining attention around the nation.

It’s not that Shriver considers himself too important for
such mundane tasks. It’s just that from the moment he walked into the Factoria
Medical Center clinic every morning until he left, he spent the entire day
going from exam room to exam room without stopping. Typically, he saw up to 24
patients daily, with problems from the simple—a case of the flu—to the
complex—an elderly person with both diabetes and heart disease. When he wasn’t
with patients, he was working his way through paperwork. Each day was, quite
simply, grueling, and Shriver began thinking more and more about retirement.

Today, Shriver sees half as many patients in a day and
spends a leisurely 30 minutes with each. That arrangement gives him time to
communicate well with patients, to sleuth through health concerns physical and
emotional. He picks up the phone when his patients call, and he answers their
e-mails. Shriver’s even been known to hand out his home number.

He’s never been happier in his 35 years of practice—and he
believes his patients have never been healthier. Emergency room visits are down
for his patients, as well as for those of his fellow physicians at the Factoria
clinic. Patients are following medical orders better and are more successfully
managing chronic conditions. And Shriver has put off thoughts of retirement.
“I’m having too much fun,” he says.

This new approach to health care, known as the medical home
model, is being pioneered by Group Health and Swedish Medical Center here in
Seattle. Simply put, the medical home concept turns the current model of
primary care—mostly provided by internists, family practice doctors and
pediatricians—on its head.

At present, the vast majority of primary care doctors are
reimbursed per procedure or based on the number of patients they see. That
method means primary care doctors, who already receive some of the lowest
reimbursements of any physicians, work long days and are able to spend only
perhaps seven to 10 minutes on each patient. Often, they’re double booked: two
patients are in separate exam rooms with the same appointment time. Because
doctors aren’t paid for double booking and they’re already burdened with
paperwork, it’s difficult for those in primary care to spend much time on the
phone with patients, let alone to

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