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                        JeffNEWS, October 5, 1994
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Patients and Their Doctors Must Be Partners in Healthcare Future
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By GENO J. MERLI, MD
   Director, Division of Internal Medicine, Department of Medicine

It's clear that the future demands of health care are already changing 
relationships between doctor and patient. The changes in primary-care 
relationships are especially meaningful. 

Already we are seeing benefits from the primary-care doctor and patient 
forging "partnership" relationships. This means that both doctor and 
patient are honing their consumer awareness skills. While patients continue 
to inform themselves as consumers, primary-care doctors can play a key, 
almost essential, role in the consumer education of their patients. 

We can measure how good a doctor/patient relationship is by seeing how 
willing patients - who are really healthcare consumers - are to reform 
their own health-affecting behavior. As doctors, we will want to see how 
well our patients will adopt effective and appropriate self-care. We will 
want our patients to become informed and prudent consumers of specific 
health services and to be partnered managers with their doctors of their 
own chronic conditions. It is important that physicians meet this challenge 
because we will find consumer-educated patients will be one of our best 
resources under capitation.

One part of the new challenge - of what some call "relationship 
building"- means physician and patient sharing responsibility for the 
consumer education of the patient. The relationship of the future must be 
of patients who inform themselves about their own health care, including 
prevention, and of primary care doctors who help patients with their self-
education. Together, they form a lasting relationship benefiting both 
parties. 

Both doctor and patient must now understand that good health is no 
longer defined mainly by reacting to illness. Rather, good health now means 
doctor and patient actively working and learning together to prevent 
illness. For physician and patient, this is a dramatic and challenging 
about-face for the traditional mindset of American medicine.

Our recent reorganization within the division of internal medicine 
reflects one Jefferson response to this new challenge. 

Traditionally, internal medicine's dual mission has been to educate our 
students through Jefferson Medical College and to care for our patients 
through Jefferson Hospital. As we continue to balance both sides of that 
mission through evolving healthcare reform, we have reorganized our 
division into four practice groups that philosophically draw from the best 
of our traditional education and patient care missions while simultaneously 
incorporating aspects of the new doctor-patient relationships necessary for 
the future of primary care:

   1. Clinical care. Seven faculty physicians treat hospital inpatients and 
      teach medical students and residents.
   2. Consultation medicine. Five physicians perform medical consultations 
      in the hospital as well as teach. 
   3. Other activities. Four physicians care for students and employees 
      through University Health Services and teach.
   4. Research. Four physicians perform research, primarily on healthcare 
      delivery, outcomes and informatics.

All four practice groups treat outpatients as well.

The clinical, educational, research and administrative operations of all 
four components are meshed to meet the University's goals and guidelines, 
particularly as they relate to the realities of primary-care practice and 
prevention in healthcare reform. 

As part of our expanding availability to patients, we now see 
outpatients on Wednesday evenings and on Saturdays at our Center City 
offices at Walnut Towers, 211 South 9th Street.

To support the critical consumer educational need related to primary 
care, we will publish a patient newsletter quarterly. We want to educate 
our patients about screening and specific disease processes and to clarify 
topics and issues discussed in the media.

The concepts of "relationship building" are critical in dealing with the 
new managed care healthcare delivery systems we'll be involved in. Both 
patient and physician must become better informed. Each will benefit, and 
so will their consumer and healthcare partnership.


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Information provided by:  Editor, JeffNEWS
                          (215) 955-6204
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