guthealthcare.com

Why PHCAs?

For doctors to opt to become PHCAs, it will mean, in all probability, that the opponents of retainer practices will have won, and that it finally will have become illegal for doctors to work directly for their patients.  Doctors who insist on providing unimpeded advocacy services for patients - the kind that are supposed to be provided by an intact doctor-patient relationship - will then have no choice but to abandon the practice of medicine altogether, thereby shedding the guidelines, regulations, laws and constraints with which "real doctors" will have been burdened.  

Will doctors actually do this? It is entirely likely that some will. Doctors like me - the older kind, the kind who once were able to practice medicine relatively unencumbered by MBAs, intimidating federal regulators, and high-school graduates reading from lists of covered services - are ready to leave the practice of medicine in droves. There are lots of reasons for this, including all the ones you've heard - the drop in income, the mounting paperwork, the oppressive regulations, and the loss of control over their practices.  They're all good reasons, too.  The main reason doctors are frustrated, though, is that they can no longer practice medicine the way they know they should.  They cannot truly be their patient's advisors and advocates. This is really why so many doctors are at least talking seriously about leaving medial practice.  

It is at least reasonable to suppose that some doctors will be attracted to such a thing as the PHCA profession. As PHCAs, doctors will be able to shed all the encumbrances of modern medical practice, and concentrate on the one thing doctors ought to be concentrating on but cannot - advocating.  Many conscientious doctors will find this prospect attractive, even at a substantially lower income, and especially if they are otherwise considering leaving medicine altogether.

What will PHCAs do?

I have already had the audacity to propose a new medical profession. Why not extend that audacity to suggesting particular services this new profession might perform?

The primary mission of the PHCA will be to supplement (or even replace if need be) the advocacy role traditionally provided by an individual's physician.  This goal implies an ongoing relationship between the client and the PHCA.

Thus, PHCA services are likely to be provided, whenever possible, on a subscription basis. Subscription services might generally fall into two categories - intake services and ongoing services.  In addition, special ad hoc services will be available.  In all instances, the emphasis of the PHCA should be to educate, to advise, and to advocate for their client.

Subscription services

Intake services

Intake services might include:

-  introduction to and interview with the PHCA (for local clients, in-person interviews are preferable; on-line or telephone interviews can be used for long-distance clients)

-  complete medical history by the PHCA

-  critique of client's health insurance plan

-  develop a list of the client's overt and potential health problems, and a set of overall healthcare goals

-  PHCA begins coaching client on how to become a more effective patient

-  with specific healthcare goals in mind, PHCA develops specific recommendations on how the client can optimize the care he/she is receiving

-  initiate formal discussions on living wills and organ donor options

-  instructions on accessing ongoing services

-  assistance in obtaining client's medical records, to build an ongoing centralized medical record that can be controlled and accessed (i.e., owned) by the client

Ongoing services

Ongoing services might include:

-    develop ongoing relationship between client and PHCA

-   "coaching" service before key doctor's appointments (strategy session prior to doctors visit: decide what medical issues need to be resolved, what information will be needed in order to make decisions, what questions to ask the doctor to gain that information)

-   "debriefing" service after key doctor's appointments (critique of what transpired during visit to doctor, assessment of adequacy of the plan developed by the doctor and client, assessment of whether there is a need for follow-up contact with doctor prior to next scheduled visit)

-    timely revision of client's medical problem list and goals

-    continual updating of client's computerized medical records

-    secure access to computerized medical records by client 24 hours/day

-    with client's permission, providing doctors with data from client's computerized medical records

-    replying by phone or e-mail to any non-emergency healthcare questions within 24 hours

Ad hoc services

Ad hoc services will be more active and more direct than intake or ongoing services. Whereas intake and ongoing services take place outside of the traditional healthcare setting (i.e., in an office or on-line), and at a time other than when the client is actively undergoing a healthcare episode, ad hoc generally will take place during the healthcare episode itself, and may occur on-site if necessary (and if possible).

-  assessment during healthcare episode (such as hospitalization) of client's healthcare status, needs and appropriateness of care

-  ongoing monitoring of client's condition/status during healthcare episode

- directly communicating or negotiating on client's behalf with physicians, hospitals or insurers, to clarify issues of care (such as definition of the medical problem(s), defining the diagnostic and therapeutic options, defining the risks and benefits of various options, clarifying the physicians recommendations, assessment as to the adequacy of care).