President's Message,  Carla Kakutani, MD

HAVE YOU EVER TRIED to give a visitor directions to a destination that you are so familiar with you could get there in a fog bank? And as you try to explain, you realize you don't know the street names because you know the way so well that you just don't need them?

I think this is the reason we have problems when we try to explain the concept of the primary care medical home to legislators and the public. After all, we do this stuff every day. It feels so obvious and self-evident to us that we have a surprisingly hard time putting it into words. And if you only have a few minutes to lay it all out to a legislative staffer (or your brother-in-law, for that matter), it does get challenging!

With that in mind, here is my attempt to define the medical home in a way that everyone can understand. Remember: if the public doesn't understand it, they will never be convinced that they need it. No amount of research will impress lawmakers, but public pressure will.

The medical home is a team, led by a primary care physician, who:

• knows the patient and keeps the patient's medical records;
• guides and provides preventive care, such as cancer screenings and immunizations;
• treats patients for acute illness;
• guides patients to the most appro-priate setting for individual needs or questions: Web sites, e-mail, phone call, face-to-face visit, sub-specialist referral, urgent care or ER; and,
• serves as an advocate and health information translator for patients.

Think of the improvement we could make to the health of our communities if every Californian had a medical home! Think of the money saved when people no longer need to show up in the ER just to find care, or when redundant labs and x-rays are not ordered because records are up-to-date and available. Best of all, think how much fun it would be to provide this care to your patients and be appropriately compensated and valued for it!

Right now there is nothing in the various health care reform proposals in Sacramento that paves the way for Californians to find their medical home. Giving millions of people a plastic card but no plans to provide them a place to go may very well make a bad situation worse, and certainly will not control costs. No one is forwarding proposals to shore up primary care payment, pipeline or prestige - essential elements to building the medical homes our state needs.

No one except CAFP, of course. Our Medical Enterprise Zone legislation, AB 1134, is an attempt to provide family physicians some tools (tax credits, loan repayments) to build medical homes in currently underserved areas. The Cognitive Coalition - our partnership with pediatrics, internal medicine and psychiatry - will be expanding to bring the primary care medical home message to a bigger audience. Our participation in CMA's primary care technical advisory committee will hopefully convince the rest of organized medicine in California of the urgent need to advocate for primary care. We will continue to monitor UC's plans for new medical schools and keep the pressure on them to do more to provide California the health care workforce it really needs, not the one that brings in fat research grants.

CAFP has a dedicated crew of staff and physician leaders working on these projects and getting the medical home message out and understood. You can help by educating your patients, family, friends and colleagues about primary care and the medical home. Show them how improved quality and decreased costs to the system flow from improved primary care access.
On one of my trips to Sacramento in April, I had an experience that makes me optimistic that we are going to make headway with this message. Dr. Asma Jafri, Dr. Larry Dardick, Sharon Lin, Jose Avalos, Tom Riley, Adam Francis and I had just finished meeting with an assemblymember's staffer to discuss health care reform.

I gave him my card and thanked him for his time, then slipped out of his office to make way for everyone else to leave. The staffer practically ran after me! "You work in Winters? My wife and I live in Davis, and we really don't have a regular doctor. Are you taking new patients?"

If an insured professional is having so much trouble finding a primary care medical home that he would be willing to drive 15 miles in the opposite direction from work to get one, then maybe there is hope that people are really starting to get it!