We are actively working to make MDM a reality in our primary care practice. A key step involves identifying patients who may benefit the most from MDM, or the most intensive form of MDM at least.
After some discussion we came out with this list (order does not necessarily implies importance)
- Patient has a complicated treatment regimen and is overwhelmed by it (as judged by self report, nonadherence or other strong clue)
- The current form of care does not meet the patient’s needs
- The patient’s health is at risk of a health catastrophe if we do not take action
- The patient is willing to invest in MDM work with the goal of achieving the patient’s goals for life and healthcare while reducing the burden of treatment (the imbalance in patient workload to patient capacity)
We will probably need to develop some criteria to flag charts in a busy primary care, yet all these require “conversation” – the healthcare team needs to become aware of the first one, needs to realize the second and third one, and needs to engage the patient for the last one.
I look forward to your thoughts and ideas on who would benefit the most from MDM?
Minimally Disruptive Medicine 