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The Cost-Effectiveness of Family Physicians

May 11, 2013
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Something has just come up. I’ll get back to complaining about Dr. Oz in a few weeks. In the mean time:

I just had a paper published in the journal Family Medicine that took a long time to get here, but the wait was worth it. It has great stories explaining why family physicians deliver better healthcare at a lower cost. If you want to be efficient, read the Results, Table 3, and Figure 1. Here is the link to the paper http://stfm.org/fmhub/fm2013/May/Richard311.pdf

For the next few posts, I will take some of the concepts in the paper and expand just a little. For today, I provide an overview.

Me and my fellow researchers uncovered lots of themes backed up with great stories about the ways family physicians deliver better care at a lower cost. We arranged these themes into an explanatory model, Figure 1, that transition from some abstract concepts to the practical behaviors that explain the outcomes.

We found that the two foundational themes of this model were that 1) family physicians had different personal characteristics, attitudes, and behaviors than other physicians, and 2) this skill set on their part was combined with a deep knowledge of their long-term patients. By the second point, I don’t just mean the patients’ chronic diseases, but a deeper sense of what makes those patients tick. Not only what tests they had 10 years ago, but even how they looked and reacted as they described the symptoms that led to the test in the first place.

A great example of this phenomenon is the first story in Table 3. Out of respect for copyright issues, I won’t re-print the story here, but if you just have a minute, click on the link above and read this story. It’s on page 316.

The connecting feature of these two themes is trust. I believe family physicians have a different set of values and assumptions about the proper use of the healthcare system than many Americans. Patients will often be willing to change their minds about their pre-conceived notions of whatever test or referral they think they need, but they will only do so willingly if they trust their physician. This trust is not given just because the physician has a white coat and a degree. It comes from a long-term relationship full of lots of brief stories of concerns paired with reassurance and healing between patient and physician.

The two two themes — family physician characteristics and long-term doctor-patient relationships — then explain a long list of behaviors and decision-making patterns that emanate from this relationship. More on that next time.

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