Wow! They do care: A patient-centered medical home

Dr. Lester Hartman of Westwood-Mansfield Pediatrics sent out an email message to the parents of his patients, as part of his new initiative to get to know his patients. He is trying to get to a four-star rating on knowledge of patients by the doctor, according to patient surveys conducted by Massachusetts Health Quality Partners (MHQP).

He asks the parents, "What is important for us to know about your child?". His staff then enter the answer into the electronic medical record, in a prominent yellow PostIt area on the computer screen.

If the parent has said the child is needle-phobic, the nurse will call the parent before the visit, asking whether to give the shot at the start or end of the visit. The parents say, "Wow! They do care!"

Read another story on a patient-centered medical home.

Parents are often concerned: Dr. Hartman's patient communication

As a father with 19 years of parenting experience, I sometimes have to decide whether to bring my child to the pediatrician. If it will help, of course, I'll bring in my son or daughter, but if not, I'd rather not spend the time. So I call the doctor's office, and either talk to the receptionist or the nurse, and decide with them whether my kid's complaint is worth a doctor's visit. It’s helpful to have guidance from the doctor's office.

Some pediatricians are starting to think more systematically about how to partner with their patients in this decision. Dr. Lester Hartman of Westwood Pediatrics, outside of Boston, has innovated in several ways.

In Dr. Hartman's office, staff routinely collect the email addresses of their young patients' parents of their patients. He sends an e-newsletter to teach them when to come in for a sore throat, what croup looks like, and so forth. "One Saturday while being on call," he says, "the nurse practitioner and I must have seen 30 children with influenza. It is the same old story – the child has a cough and complains of a sore throat and achiness. The parent focuses on the sore throat, worrying about strep or pneumonia. We sent out an e-mail that evening stating to parents: 'We often realize when parents bring their child into the office during flu season, parents are often concerned about pneumonia or strep throat. Interestingly, most children who complain of sore throats say it is a minor symptom compared to their headaches and body aches. If your child says this when you ask then it is unlikely to be strep. Coughs and high fevers are very common in flu season and do not represent pneumonias. Call if your child has the following symptoms….Remember your child can have a fever for 5-7 full days.' The next day we saw two-thirds fewer children with the flu.”

At the end of the newsletter you can state that no emails sent back will be responded to.

Dr. Hartman was able to tell most of the parents – i.e., the vast majority who had email – what to watch for, and how to respond.

Advice to parents: Get a pediatrician like Lester for your kids.

Disclosure: I'm proud to have Lester as a close friend. We've had many backyard discussions on these topics over the years.

Read about a very different kind of communication about children's medical care.