The Emporer's Fashion Show

Oh, fer cryin' out loud!

I've resisted weighing in on the latest and greatest [/sarcasm] gift to medical practice, promulgated by my very own AAFP and known as the "Patient Centered Medical Home," because frankly, it's all a crock of shit.

For those readers still blissfully ignorant of what I'm talking about, feel free to click on the above links and the explanatory links within. But beware of terminal boredom and irony overload.

KevinMD and others have discussed this topic ad nauseum. It is the source of endless angst among family doctors in solo and small group practice, because the structure of the PCMH excludes us by definition. The PCMH is advertised to work best in large group practices like Kaiser and the Mayo Clinic. All I can say is "DUH!"

You know what the PCMH really is? Nothing more than this:

IT'S A WAY TO MAKE LARGE GROUP PRACTICES WORK MORE LIKE A SOLO DOC!!!

I am already performing every meaningful function of the PCMH. So is virtually every physician in solo and small group practice. There is absolutely nothing to be gained -- and a significant amount of money to be lost; this thing is expensive! -- by adopting any of this PCMH shit. Somehow that doesn't seem to stop our Academy from tossing us to the wolves by simply ignoring us.

None of the "reforms" currently coming out of Washington have a prayer of actually impacting health care in this country. The enormous sums labelled "down payments" are going to be put to use in exactly the same manner as AIG used their federal trough bailout money. No one who has any direct involvement with patient care will see a penny. Those who are already rich beyond the dreams of avarice will be enriched further, not that any amount of money will fill the hole in their soul that forces them to continue their meaningless accumulation of monetary wealth.

Nothing in this country will change until patients change how they view and use health care, and until doctors reclaim their professionalism and change how they approach the business of medicine.

No idea what I'm talking about? Stay tuned. It's the subject of my next book.