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Research ArticleSpecial Communications

Having and Being a Personal Physician: Vision of the Pisacano Scholars

Jennifer E. DeVoe, Terri Nordin, Kristen Kelly, Marguerite Duane, Sarah Lesko, Saria Carter Saccocio and Lenard I. Lesser
The Journal of the American Board of Family Medicine July 2011, 24 (4) 463-468; DOI: https://doi.org/10.3122/jabfm.2011.04.100293
Jennifer E. DeVoe
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Terri Nordin
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Kristen Kelly
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Marguerite Duane
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Sarah Lesko
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Saria Carter Saccocio
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Lenard I. Lesser
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Article Figures & Data

Tables

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    Table 1.

    Characteristics of the 25 Pisacano Scholars and Alumni Who Participated in the Jackson Hole Conference on Personal Doctoring Compared With All 96 Pisacano Scholars and Alumni

    Participant Characteristics25 Pisacano Scholars and Alumni at Jackson Hole Conference (n [%])96 Pisacano Scholars and Alumni (as of February 2011) (n [%])
    Age (years)
        <306 (24)15 (16)
        31–358 (32)19 (20)
        36–404 (16)27 (28)
        >407 (28)35 (36)
    Residency completion
        Currently in medical school or residency9 (36)21 (22)
        Completed residency ≤5 years ago7 (28)22 (23)
        Completed residency >5 years ago9 (36)53 (55)
    Medical school graduation year
        2010 or 20113 (12)12 (13)
        2005–200912 (48)23 (24)
        2000–20044 (16)25 (26)
        1994–19996 (24)36 (37)
    Geographic residence
        Northeast7 (28)19 (20)
        Midwest5 (20)20 (21)
        South1 (4)17 (18)
        West12 (48)40 (42)
    • View popup
    Table 2.

    What Is It Like To Have a Personal Physician?

    • Comfortable, intimate relationship, like family or friend.

    • Trust, confidence, security; having a go-to person.

    • You are known. You don’t have to retell your story. You are the exception to the guideline. You and your life’s context are important.

    • You have an advocate, navigator, coordinator for the “confusing and frightening” health care system—someone who follows up with specialists.

    • Convenient access (via office visit, phone, E-mail).

    • Shared decision making and mutual respect.

    • Knowledgeable, both in terms of personal knowledge of the patient and book knowledge.

    • Coach for preventive care/overall well-being.

    • Part of a health care team.

    • View popup
    Table 3.

    What Is It Like To Be a Personal Physician?

    Ideals
    • You know your patients’ context and story. You have a committed relationship and invest in patients.

    • You are rewarded and inspired by this professional role. You feel a sense of calling. You enjoy it.

    • Participate in and encourage collaboration and shared decision making.

    • Meeting patient needs; not focused on tests or insurance.

    • An advocate for patients’ health. A guide, navigator, negotiator, coordinator of health care.

    • Community participant and contributor.

    Challenges
    • Work can be draining—can’t be there 24/7, need team.

    • Not easy to balance professional role with personal life.

    • Cannot always provide care in appropriate setting/not enough flexibility to offer care via E-mail, phone, etc.

    • Never enough time with patients to address all concerns and get to know each other.

    • View popup
    Table 4.

    What are feasible next steps, both personal and collective, toward making our vision of personal doctoring a reality?

    System and practice-level changes
    • Restructure payment systems to better support work done outside the exam room and not face-to-face (E-mails, phone calls), mental health care, coordination of care, long-term continuous relationships. Incentivize relationship building.

    • Use electronic medical records and other technology to facilitate communication and to improve rather than detract from relationships.

    • Build team, restructure clinic work flow.

    • Educate patients and the public about the feasibility and value of having a personal physician and the need for advocacy for system change to make this widely possible.

    • Appropriately sized (smaller) patient panels.

    • Change medical school education—teach trainees to ask for patient’s perspective.

    • More actively coordinate care and avoid redundant and wasteful care.

    Individual-level changes: “One thing I’m going to do now.”
    • Add personal touches (eg, attend funerals, send birthday cards).

    • Put the focus back on the relationship. Ask patients at least one non-health care question about hobbies, family, etc.; ask about personal goals; take social histories; listen longer in the beginning.

    • Self-assessment and self-reflection: Ask self: “When am I my patient’s doctor? Am I the type of doctor I want for myself and family?” Recommit to being a personal physician.

    • Teach residents to ask for patient perspective.

    • Make sure patients know their team and use their team.

    • Assess how electronic medical records and other technologies are helping or hindering patient relationships.

    • Create price lists and post them.

    • Increase involvement in the community; build flexibility into schedule for community involvement.

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The Journal of the American Board of Family Medicine: 24 (4)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 4
July-August 2011
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Having and Being a Personal Physician: Vision of the Pisacano Scholars
Jennifer E. DeVoe, Terri Nordin, Kristen Kelly, Marguerite Duane, Sarah Lesko, Saria Carter Saccocio, Lenard I. Lesser
The Journal of the American Board of Family Medicine Jul 2011, 24 (4) 463-468; DOI: 10.3122/jabfm.2011.04.100293

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Having and Being a Personal Physician: Vision of the Pisacano Scholars
Jennifer E. DeVoe, Terri Nordin, Kristen Kelly, Marguerite Duane, Sarah Lesko, Saria Carter Saccocio, Lenard I. Lesser
The Journal of the American Board of Family Medicine Jul 2011, 24 (4) 463-468; DOI: 10.3122/jabfm.2011.04.100293
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