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:
- a patient-centered approach to care, which reaffirms the core principles of medical ethics and professionalism
- access to a personal physician who provides coordinated comprehensive care through an integrated team
- involvement of patients, families, and caregivers in care, thereby supporting respect for patient wishes and autonomy
- practice-based system improvement and explicit attention to quality
“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 SGIM say.
American College of Physicians