Medicine from the heart . . . PCMH clerkship reflections

December 13, 2012

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.

Carole Upshur, EdD, professor of family medicine & community health and the department’s director of research training and development, shares reflections from medical students about patient-centered medical homes (PCMH). At a time when many are being challenged by the transitions of PCMH, these are welcome observations about successes to date.—Hugh Silk, MD

Reflections on Patient Centered Medical Home Clerkship

Introduction from Carole Upshur

The four students participated in the Clinical and Translational Research Pathway/Fall Population Health Clerkship group, which conducted patient surveys focused on PCMH issues in four Department of Family Medicine & Community Health-affiliated practices. The first three students are not necessarily considering primary care. The fourth, who has always planned to become a family practitioner, shares how participation in the PMCH Population Clerkship Group has influenced her view of primary care.

Karen Tenner, SOM ’15

Regardless of what specialty I choose, as I move toward eventually beginning my own clinical practice, I want to always hold on to the ideals of the patient-centered medical home. It is crucial to consistently work to create a system that is focused on what is best for the patient. I want to be able to move away from what seems simplest and easiest for me as a provider and work to initiate, implement and embody practices that are best for my patients. Beyond that, I think learning about the PCMH has made me much more aware of the importance of collaborating with other essential, and perhaps sometimes under-utilized, members of the health care team.

John Madore, SOM ’15

I now view the patient-centered medical home as an important and sustainable model of health care which will provide vital primary care treatment to adult and pediatric patients. Observing different health care providers working as a team and being advocates for their patients was inspiring. I hope to be a physician in the future who can work well with others on a team, be a part of the community where my patients live, and serve as an advocate in their lives.

Caitlin Lawrence, SOM ’15

It helped me to understand where I might fit into the flow of health care if I decide to pursue a role in primary care. It makes me nervous, however, to enter a profession that is in such a state of change. Seeing [my clerkship location] transform up close has helped me to learn that uncertainty is also empowering, that it can bring pride, purpose and energy even to those who have been in the profession for decades.

Juliana Clough, SOM ’15

Even before starting medical school, I knew that I wanted to strongly consider a primary care career . . . on the other hand, I am scared. Even as a student, I have felt the pressure of having to finish up with the patient in front of me just so I can rush to the next one. I have seen the mountains of paperwork on my preceptor’s desk that keep her in the office into the night. I have felt that horrible feeling in the pit of my stomach when I saw her partner’s empty office, a casualty of burnout. I love this field so much, but with low pay, high debt and so much administrative nonsense ahead of me, I get scared that I won’t be able to do it.

Imagine my amazement, then . . . [hearing about] the transformation of practices into patient-centered medical homes. Wait, so let me get this straight. There’s a way to improve quality, increase access to doctors, reduce administrative burden on doctors, satisfy patients, improve the health of even the very sickest patients by leaps and bounds, AND greatly improve physician morale? No way. There’s got to be a catch. I had been extremely impressed with [my clerkship location] over the few days that I worked there, but I had no idea what the full potential of such a model could be. It makes part of me wonder why the entire country isn’t scrambling into this model immediately; however, it must take so many resources and buckets of support to make change happen, and with limited data available on the effectiveness of a PCMH, doctors may not really know what they are getting themselves into. I am so impressed that UMMS took the chance on this great experiment, and I can’t wait to see the impact on both patients and providers. I am re-energized knowing that I have the power to take control of my career if I choose to go into primary care, and so excited about the ability to go above and beyond for my patients . . . this clerkship gave me so much hope. I see now that changes in primary care are being made that I never thought were possible. I absolutely cannot wait to see what is in store for the field.