What if the nurse probes further into how you scraped your knee (assuming a simple fall)? Maybe you tell her you've been having back problems lately or haven't been getting much sleep at night. Maybe you offhandedly mention an ear infection or she smells a hint of alcohol on your breath. There's a multitude of possibilities. The above could result in a referral to the orthopedist, a sleep specialist, an ears/nose/throat doc (ENT), or a social worker, respectively.
The way care is delivered right now though is very incidental. Patients are rarely looked at from a holistic sense of "what else is going on in their lives?" A lot of it has to do with how doctors are paid (fee for service) and the medical home model is one effort to correct that by getting insurance companies to pay additionally for coordination of care. This is what PCPs have been doing pro bono till now. Paying for a central model though builds in many other benefits:
- Pooled resources
- Central point of contact
- Change in perception
- Enhanced communication
- Better monitoring
- Standardized Best Practices