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 Im 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.