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PCMH presents opportunity to reinvigorate the
patient-physician relationship and can provide pathway to enhance
the ethical practice of medicine
PHILADELPHIA, July 30, 2012 -- The American College of
Physicians (ACP) and the Society of General Internal Medicine
(SGIM) explore the ethical dimensions of the patient-centered
medical home (PCMH) in a new position paper published by the
Journal of General Internal Medicine: "The
Patient-Centered Medical Home: An Ethical Analysis of Principles
and Practice." The text is also available on ACP's website.
"The PCMH model of care aligns well with the traditional
principles of medical ethics and professionalism, including the
duty to promote the good and act in the best interest of the
patient, the duty to do no harm to the patient, and respect for
patient autonomy," said David L. Bronson, MD, FACP, president, ACP.
"This position paper highlights some of the practical choices and
implications of PCMH design and implementation that should be
considered to ensure that this model of care becomes a key
ingredient in better health care for patients."
In the paper, ACP and SGIM examine how the PCMH meets four
fundamental ethical principles by facilitating:
"The extent to which the practical implementation of the PCMH
achieves ethical goals is likely to depend significantly on design
features, such as the structure of physician payment and the
measurement of patient satisfaction and experience, quality of care
and patient outcomes, cost of care, and further health care
reform," said Ann B. Nattinger, MD, MPH, president, SGIM.
Noting that many Americans are currently "medically homeless"
and patients without access to care face a "perilous journey" as
they try to navigate the health care system, the PCMH holds promise
to substantively rectify this situation, bringing the health care
system closer to the ideals of medical ethics and professionalism,
ACP and SGIM say in the paper.
The organizations also note practical barriers to meeting some
goals. For example, access to a personal physician responsible for
coordination of care presents a challenge because of the shortage
of primary care physicians.
ACP and SGIM say that the PCMH strongly supports the "bedrock
principle" of patient autonomy because the concept of
patient-centeredness that forms its foundation emphasizes patient
engagement, provision of health information to patients, and
involvement of patients in shared decision making.
By integrating system improvements into the practice
environment, the PCMH could help physicians meet the ethical
obligations for quality improvement and patient safety, ACP and
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 133,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internists specialize in the prevention,
detection, and treatment of illness in adults. Follow ACP on
Twitter and Facebook.
About the Society of General Internal
SGIM is a member-based international association of over 3,000 of
the world's leading academic general internists, who are dedicated
to improving access to care for vulnerable populations, eliminating
health care disparities and enhancing medical education. The
members of the Society advance the practice of medicine through
their commitment to providing comprehensive, coordinated, and
cost-effective care to adults, educating the next generation of
outstanding physicians, and conducting cutting-edge research to
improve quality of care and clinical outcomes of all patients.
Visit the Society at www.sgim.org.