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The Patient-Centered Medical Home: An Ethical Analysis of Principles and Practice

  • Health Policy
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ABSTRACT

The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient–physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

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Acknowledgments

Financial support for the development of this position paper came from the ACP operating budget.

*Members of the 2009–2011 American College of Physicians Ethics, Professionalism and Human Rights Committee: Virginia L. Hood, MBBS, MPH, FACP (Chair 2009–2010); Kesavan Kutty, MD, MACP, FCCP, FRCP (L) (Chair 2010–2011); Joseph J. Fins, MD, FACP (Vice Chair 2009–2011); Jeffrey T. Berger, MD, FACP; Clarence H. Braddock, III, MD, MPH, FACP; CPT. Tatjana P. Calvano, MC, USA; Kathy Faber-Langendoen, MD, FACP; Faith T. Fitzgerald, MD, MACP; Thomas H. Gallagher, MD, FACP; Celine Goetz; Vincent E. Herrin, MD, FACP; Robert G. Luke, MD, MACP; Tanveer P. Mir, MD, MACP; Alejandro Moreno, MD, MPH, JD, FACP, FCLM; Amirala S. Pasha; J. Fred Ralston, Jr., MD, FACP; Michael C. Sha, MD, FACP; Upasna (Mini) Swift, MBBS, FACP; Alexandra Smart, MD; and Barbara J. Turner, MD, FACP. This paper was approved by the ACP Board of Regents on July 30, 2011.

**Members of the 2010–11 Society of General Internal Medicine Ethics Committee: Clarence H. Braddock, III, MD, MPH, FACP (Chair); Eric G. Campbell, MD, PhD; Evelyn C. Chan, MD; Sarah L. Clever, MD, FACP; Matthew DeCamp, MD, PhD; Neil J. Farber, MD, FACP; Thomas H. Gallagher, MD, FACP; Lauris C. Kaldjian, MD, FACP; Eliseo J. Perez-Stable, MD, FACP; Sonja K. Rakowski, MD; Lois Snyder, JD; and Alexia Torke, MD. This paper was approved by the SGIM Council on June 29, 2011

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The authors declare that they do not have a conflict of interest.

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Correspondence to Lois Snyder JD.

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Richard L. Neubauer, MD. Deceased

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Braddock, C.H., Snyder, L., Neubauer, R.L. et al. The Patient-Centered Medical Home: An Ethical Analysis of Principles and Practice. J GEN INTERN MED 28, 141–146 (2013). https://doi.org/10.1007/s11606-012-2170-x

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