Imagining a patient centered healthcare system

Many complain about our current healthcare system but little has been accomplished to make it patient centered. I believe that a patient centered healthcare system can be accomplished by using a patient owned healthcare cooperative model that is free from the constraints of the CPT codes used for billing and by providing financial incentives to patients to be compliant and lead a healthy lifestyle. Physicians rather than insurance companies and administrators should be responsible for care and would be compensated based on results. Profits from the cooperative would belong to the patients rather than an insurance company. One vision of  healthcare in the future is described below. Changes could begin incrementally, starting out with a conventional healthcare cooperative. Utilization of these changes should be voluntary on the part of the patient.

Imagining a patient centered healthcare system

Screening for disease.

An annual physical examination including physical and mental fitness, weight, vital signs and age appropriate screening tests would be performed. If disease is found, appropriate treatment is begun.

Acute Illness

Rather than making an appointment to see a doctor or go to the ER/ Urgent Care, the patient can tap an app on the smartphone and talk to a physician in a few minutes. The patient would grant access to the physician to his/her medical record. The patient would report the symptoms as well as vitals signs – Blood pressure, pulse and temperature. (every patient would have the means of measuring these.) The physician could take the history and do a telemedicine exam; order lab tests and imaging; summon an ambulance; supervise the EMT’s; order transport to the hospital as necessary and treat the patient during transport.

If patients are well enough, they can go to the imaging center that also has a drawing station for blood work by car or  “cabulance”. Alternatively, blood work, EKG, plain x ray and ultrasound can be performed at home. This would all be performed the same day or night.

Most patients will not be very sick and simply need a diagnosis, reassurance, oral medication or first aid instruction. If necessary, diagnosis can be aided by AI.

Simple procedures e.g. suture of laceration can be provided by skilled technicians that come to the home and supervised by the physician

Sicker patients can be cared for at home with an aide to help with routine care and food preparation. Nurses can administer intravenous treatment; oxygen therapy and medication.

They can draw blood and help physicians perform telemedicine exams. The original doctor can call in specialists that can consult via telemedicine or if necessary in person. If necessary, treatment can be guided by AI.

Patients with unstable vital signs will still need transport to hospital for treatment of major trauma, heart attacks, GI bleeding, pulmonary emboli, acute stroke. Hospitals will be better equipped to handle these patients in the ER by avoiding the clutter of patients that do not have a life threatening emergency.

Chronic illness  e.g. diabetes, obesity, hypertension, seizure disorder, mental illness

A treatment team supervised by a specialist would care for the patient. Members of the team would consist of the patient, dieticians, physical therapists, psychologists, social workers, clergy, personal trainers, medical assistants, nurses or other skilled people necessary to care for the illness. A physician designed algorithm would help guide treatment. Problems with treatment compliance could be addressed by team members as well as the physician. Visits to the physician office would be rare. Results of treatment would be measured in terms of end organ damage e.g. to the heart, kidney, brain,musculoskeletal system.

Diagnostic Problem Cases.

When a patient has a symptom that is not resolving with initial treatment or where the diagnosis

Is not clear e.g. cause of dizziness, cause of anemia, breast lump found on mammogram, a diagnosis should be arrived at in a few days and appropriate treatment begun. This can best be accomplished if the patient goes to a facility where tests and specialty consultation can be performed in a few days. This facility would not provide nursing care or overnight stay. But would have a quiet space for patients to study and read; other space for a gym, TV, video games or other entertainment. There would be Exam rooms for specialists. Laboratory and imaging would be available on site with a 24 hour turnaround. Specialists would see the patient the same day or next day. This is similar to a hospital without beds, nursing care and bedside food service. Once the diagnosis is made, a treatment should be established and begun in 24-48 hours. The center would be judged on accuracy of diagnosis as well as efficiency.

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