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

doi:10.3122/jabfm.2011.04.100293

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 Characteristics	25 Pisacano Scholars and Alumni at Jackson Hole Conference (n [%])	96 Pisacano Scholars and Alumni (as of February 2011) (n [%])
Age (years)
<30	6 (24)	15 (16)
31–35	8 (32)	19 (20)
36–40	4 (16)	27 (28)
>40	7 (28)	35 (36)
Residency completion
Currently in medical school or residency	9 (36)	21 (22)
Completed residency ≤5 years ago	7 (28)	22 (23)
Completed residency >5 years ago	9 (36)	53 (55)
Medical school graduation year
2010 or 2011	3 (12)	12 (13)
2005–2009	12 (48)	23 (24)
2000–2004	4 (16)	25 (26)
1994–1999	6 (24)	36 (37)
Geographic residence
Northeast	7 (28)	19 (20)
Midwest	5 (20)	20 (21)
South	1 (4)	17 (18)
West	12 (48)	40 (42)

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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.

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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.

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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.