Health Reform and Family Medicine

On Thursday, July 22, I said goodbye to a University of Iowa third-year medical student. The student had been with me for a month.

One of my favorite professors while I was a student at the University of Notre Dame always said that the best way to learn something is to teach it. This was the seventh medical student I have had in my practice in eight years. I have learned so much about my belief in Family Medicine by teaching these students and sharing my patients with them.

The student I said goodbye to was special. My clinic was his first clinical rotation of his medical career; he treated his first patient in my exam room. He began learning the art of diagnosing and treating medical conditions in my clinic. Equally important, he started learning the art of relating to patients and learning their stories. I have 2,200 patients in my practice. Each one has a story. They have parents, spouses, children, grandchildren, careers, hobbies, aspirations, and fears. The context of their lives affects their medical conditions–both cause and treatment. It was fascinating watching his progress from his first day with me until he finished the rotation.

All my medical students have gone on to residencies in cardiology, pediatric neurology, anesthesiology, family medicine, and other medical specialties and were able to interact and learn from my staff and my patients. Frequently, my patients told my most recent student how much they thought of me as their family physician. In response to patients saying that I was the “best” physician, my student would say that is what he had been told by other patients. I, in turn, told my student that I had the “best” patients. The key is that patients of family physicians, as well as internists and pediatrician, feel just as my patients do about their primary care physicians and many think their physician is the “best.” I teach my medical students that this patient-family physician relationship is the key to a successful practice. This relationship with my patients is why I became a family physician. These relationships allow patients to trust their physician to answer their questions about physical and mental health, preventive care, and some day, palliative care. My medical students are always amazed by the variety and severity of the health issues of my chronic care medical patients. These patients see their specialist for specific treatment of their chronic conditions, but it is I or other family physicians that help them with their daily lives. For example, in one day, my medical student and I saw two patients who had early age strokes. The strokes left them significantly disabled. Luckily, both of these patients had supportive spouses available that allow them to continue to enjoy enriching lives.

I value these relationships even more since I started teaching medical students. As I have I said in previous blog posts about the value and benefit of health coaches, coordination of care, and patient-centered medical homes, I firmly believe that primary care physicians can and do improve the cost of health care, which leads to an important connection to health care reform.

Imagine my chagrin this week when I found that one of my long-term patients, who my health coach/certified application counselor had signed up for Coventry Insurance on the Exchange during the open enrollment period in 2013 for his first health care policy in 2014, now has new 2015 coverage under a Coventry Insurance policy. Consequently, by enabling my patient to receive health insurance coverage he is now prevented from seeing me; his long-time family physician. I guarantee that my patient was not informed that his 2015 policy changes would lead to this restriction. I am afraid that this patient and I will limp along in a less than ideal relationship until 2016 when he can find a new health insurance option that has my clinic in his network. The lesson here is that patients need to fully understand the insurance policies they choose.

The vagaries of health reform continue to become evident. I still maintain the goal of universal health care coverage. It is worth the cost. I also maintain that the bond between patient and family physician is valuable, therapeutic, productive,   and cost-effective. As I learned again this month, the bond–the relationship between family physician and patient–is mutually rewarding.