With too many patients leaving their doctor’s offices confused, dissatisfied and not receiving the recommended care for their chronic diseases, many physicians have begun to look for creative ways to restructure office visits.
One increasingly popular approach is the “teamlet,” or little team, model that was developed by Thomas Bodenheimer, MD, a primary care physician in San Francisco.
A teamlet consists of a health coach and a doctor. It’s similar to the system for primary health care that’s used in England, where doctors rely on nurses to provide most chronic and preventive care and to do routine tasks like refilling prescriptions.
The health coach meets with the patient before the clinical exam to determine priorities for the visit, take a basic history, check on medication use and order lab tests. Then the coach stays in the exam room while the doctor is working, partly to assist the physician with procedures and paperwork, but also to help the patient by recording important details of the visit and keeping the visit in line with the patient’s priorities.
After the exam, the health coach remains behind to make sure the patient understood what took place and what they need to do to improve their health. They may also “close the loop” by asking the patient to repeat back their understanding of each item of advice given during the visit. While that may seem condescending, there’s a good reason for this exercise. Studies show half of patients don’t understand their doctor’s instructions.
Between visits, health coaches follow up with patients by telephone and e-mail to check on their progress.
