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Even patients with a doctor in the family face challenges in receiving optimal medical care

The complicated American health care system can be difficult to navigate. Patients are faced with complex decisions in a system that is often fragmented, episodic, and disease oriented. Even patients who have a knowledgeable physician in the family to act as their advocate face challenges in receiving optimal medical care, concludes Frederick M. Chen, M.D., M.P.H., of the Agency for Healthcare Research and Quality.

Dr. Chen and his colleagues sent E-mail invitations to chairpersons of U.S. academic departments of family medicine asking them to describe recent personal experiences with the health care system when a parent was seriously ill. They conducted in-depth interviews with eight family physicians, who had been practicing for an average of 19 years, who wanted to talk about their fathers' health care experiences.

These doctors witnessed numerous obstacles to quality care for their fathers, such as poor communication and fragmented care, which in many cases compelled them to intervene to "rescue" their fathers from medical mistakes. They were concerned about the care their fathers received and felt that the system did not operate the way it should. They suggested that patients might receive better treatment if health care systems reinforced the role of an accountable attending physician, encouraged continuity of care, and emphasized the value of knowing the patient as a person.

For the most part, the physicians felt that their fathers benefited from their personal involvement. That option, however, is unavailable to most patients, a point not missed by these doctors. In fact, many struggled to reconcile their professional pride with the imperfections in their fathers' care, with some doctors even questioning their own involvement in the profession.

The informed views of these doctors raise serious concerns about how well the health care system is serving patients. The researchers suggest that payment systems and health plan rules not force discontinuity across different care settings and that physicians who have a relationship with a patient be encouraged to remain involved in their care during hospitalizations.

See "Family physicians' personal experiences of their fathers' health care," by Dr. Chen, Lorna A. Rhodes, Ph.D., and Larry A. Green, M.D., in the September 2001 Journal of Family Practice 50(9), pp. 762-766.

Reprints (AHRQ No. 02-R014) are available from the AHRQ Publications Clearinghouse.

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