Strengthen the core and stimulate progress: assembling patient-centered medical homes.

(Fam Med 2007;39(7):465-8.) This is my first column as STFM president, and my purpose is to outline why I chose this theme for 2007–2008. I will address other issues related to the patient-centered medical home (PCMH) in future President’s Columns throughout the year. I decided on this theme months before the Annual Spring Conference in Chicago and was struck by how the plenary presentations reinforced the timeliness of this choice, as have recent announcements about the PCMH and the Patient-centered Primary Care Collaborative by the AAFP. Family medicine is still in a crisis! In his plenary address at the Annual Spring Conference, Terry McGeeney, MD, MBA, repeatedly said, “Houston, we have a problem.” He described the disheartening state of family medicine clinical practice revealed by the TransforMED project. Jim Mold, MD, MPH, in his plenary presentation, presented an optimistic picture of a statewide learning community that can lead to practice improvement, but his data showed far from optimal performance. Family medicine, we still have a problem. However, I believe that we have a solution. If together we strive to assemble PCMHs, we can strengthen the provision of our core clinical services and stimulate progress toward optimal high-quality care. While this theme addresses the challenge facing our field, it also reflects my career of 25 years. Like others, my focus has been on the teaching and evaluation of core clinical skills with an emphasis on performance assessment. In Miller’s scheme for competence (knows, knows how, shows how, does), I concentrate on the latter two levels. I expect students and residents to demonstrate mastery of basic skills and follow the adage that learners respect what you inspect. My inspection involves measurement of attitudes using validated instruments and measurement of behavior using clinical performance examinations with standardized patients, paying particular attention to patient-centered care. This focus on core skills and performance resonates with the empirical studies of organizations in Jim Collins’ books Built to Last, Good to Great, and Good to Great for the Social Sectors. Visionary organizations are those that preserve core values and purpose and stimulate progress toward an envisioned future. I immediately saw parallels between this work and my personal life as an athlete and adventurer (strengthen core fitness and push for the next marathon, mountain, or whitewater), my academic career (attend to core issues and refine programs), my leadership role (perseverate on core missions and learn new skills), and my clinical work (provide basic preventive and chronic care services and attract athletes to my sports medicine practice). I invite you to reflect on the parallels with your personal and professional life—what are your core values and purpose and envisioned future? “Preserve the core and stimulate progress” is also very relevant to the discourse about family medicine’s identity. While there are disagreements about what our scope of practice should be—obstetrics, hospital care, procedures, specialization with CAQs, ambulatory care, emergency medicine—there seems to be a core that unites us: