Philadelphia: Cradle of Liberty

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Philadelphia Cradle of Liberty
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WELCOME THE DRAGONOpening the Heart of Balint

• William L. Miller, MD, MA
• Lehigh Valley Health Network
• The 17th International Balint Congress
• Philadelphia, PA
• September 8, 2011

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Ranier Maria Rilke
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A CASE
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• Who is the doctor?
• Where is the patient in Balint?
• Where is the illness located?

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Change Transformation
Established Traditional Practice Critical Mass of
Patients, Clinical Processes, Staff
Change
Change
Practice Redesign
Space Office Design
Access Design
Technology Design
Visit Types
Financial Models
Care Process Design
Identity Shift
Teams
Proactive, Planned Care
Web Portal Shared Record
Transformation
Transformation
Paradigm Shift
Patient-Centered Care
Accountable Population-Based Care
Whole Person Holistic Comprehensive Care
Citizen of Medical Neighborhood
PCMH
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Who Is the Doctor?
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Dragon Slayers?
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Observation Intervention
DOPC
STEP-UP
Direct Observation of Primary Care (1994-97)
Study To Enhance Prevention by
Understanding Practice (1996-2000)
PCD
Cross-Disciplinary Literature
Prevention Competing Demands in Primary Care
(1996-99)
NRN-D
ULTRA
Using Learning Teams for Reflective Adaptation
(2002-07)
IMPACT
SCOPE
Insights from Multimethod Practice Assessment of
Change over Time (2001-2004)
EPOCH
EPIC
NDP
National Demonstration Project (2006-08)
CQI
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Lessons About Docs

• Surprising emotional reactivity abrasiveness
  of docs
• Monumental power difference between doc and
  receptionist
• Surprising lack of self-care skills among docs
• Surprising lack of communication between docs
• Most practices want to improve, but few want to
  change
• Docs prefer hearing what to do rather than
  learning

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A Transformed Physician
Time for a Good Drink!

• Team-based Care
• Collaborative Care
• Facilitative Leadership
• Population Management
• Multiple Channels of Care
• Patient Partnership
• Transparency of Care

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Where Is the Patient in Balint?
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Patient Experience of Care Got Worse
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Where Is the Illness Located?
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Health Care Spending per capita
(US Purchasing Power Parity)
2008 OECD Data United States 7538 Germany
3737
Organization for Economic Cooperation and
Development Health at a Glance 2010
http//www.oecd.org/document/16/0,3343,en_2649_346
31_2085200_1_1_1_1,00.html
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Tomorrows Balint?
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Welcoming the Dragon!
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A Case Revisited
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Ranier Maria Rilke