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I have been in primary care for over a decade. When I think of the many patients that I have encountered, the ones that stand out the most, are those with whom I shared a “therapeutic partnership”. The experience in the exam room was a give and take, a problem solving collaborative event. I bring my clinical knowledge, my experience and willingness to listen and the patient brings their intuition, the “inner knowing” of how their body works, their history and their own research and ideas. Those are the moments that are most meaningful and are the foundation for the direct primary care model.
Like any relationship, this takes time spent with each other. Time with a doctor who gets to know you. Time with a doctor who is fully present during the interaction. The current system in many cases has sidelined the therapeutic relationship. For a long time I have been interested in the direct primary care model because it honors that therapeutic relationship. It makes a lot of sense for functional medicine too. The majority of health conditions seen by a primary care provider are chronic. They have been present for months if not decades and often the root causes can be traced back to lifestyle and other preventable factors. Twenty first century medicine means to me looking at the biological system imbalances that lead to disease. It takes time to educate and empower a patient to make long lasting lifestyle changes.
In a recent small study published in the British Medical Journal, a strong relationship with a healthcare professional made the most impact for long-term weight loss success in the participants. I believe that it takes that trusting support for long lasting change especially in the current environment. It is the stuff that happens in between the visits that counts as well. It is not unusual for a patient to email me a photo of her meal, or a quick check of allowed foods on a elimination diet. When I saw this article, it was nice to see the therapeutic relationship validated in a way that can be measured on outcome. As our healthcare system moves toward a “value based system”, where specific metrics are used to measure the healthcare delivered, it is my hope that the “value” of the therapeutic relationship is not lost. In the meantime, I am grateful to the direct primary care movement for welcoming me and to my patients who recognize the benefit of a different healthcare model.
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