Editor’s Note: This is the first of a monthly column by Mark Fourre, MD, Chief Medical Officer of Lincoln County Healthcare.

An elderly woman came into the emergency department the other day complaining of shortness of breath.

Mrs. Smith has congestive heart failure and takes a pill each day to help her body get rid of excess water. But for three days before I saw her, she had become increasingly tired and weak. Finally, when she wasn’t able to make it to the bathroom without assistance, a family member called the ambulance.

We were able to stabilize her but tests confirmed that her heart, already weak, had been damaged. She needed to spend several days in the hospital and it wasn’t clear if she would ever be able to live independently again.

When I broke the news to her, she was distraught. She didn’t want to be in the hospital. She wanted to go home, to be with her friends and family and her much-loved dog.

Mrs. Smith is a composite patient, but while she is not a real person, like most emergency physicians, I have treated someone like Mrs. Smith many times, enough to become discouraged by how her story ends.

She has several chronic diseases that she is managing with medication. While she doesn’t get around as well as she once did, she has a good quality of life with the help of friends and family.  But if something happens to make her condition worse, her health begins to unravel quickly and unless the problem is caught quickly, the damage is often irreversible.

I am telling you about Mrs. Smith because there is a perception that emergency physicians can handle anything, from chest colds to heart attacks.

In reality, that’s not true. An obvious example is that I don’t do brain surgery. But what a lot of people don’t understand is that I am not very good at caring for people with ongoing diabetes or high blood pressure, either.

Balancing medications for chronic diseases is complex. When people come to the emergency department for treatment of diabetes or congestive heart failure, they are going to the wrong doctor.

Why are primary care physicians better? They are specialists in dealing with chronic diseases and in the relationships that are behind the best kind of care. Managing a chronic disease often requires both medication and lifestyle changes like exercising more and eating better. Finding a solution takes negotiation and the relationship between doctor and patient plays a critical role in that process.

Lincoln County Healthcare is trying to do a better job of keeping patients like Mrs. Smith out of the hospital for two reasons: it’s better for Mrs. Smith and it’s less expensive. With the federal government cutting back on Medicare and MaineCare, which cover the majority of our patients, we need to offer care that is less expensive if we are going to remain accessible to our communities.

But just more affordable isn’t enough, we also want to get better, and that’s why we are investing in a new kind of practice called the Patient Centered Medical Home.

A Medical Home offers team-oriented care with physicians, nurses, educators and other providers working together to keep patients well. Care is more accessible with weekend hours and flexible scheduling so patients like Mrs. Smith can usually see their doctor the same day if they have a problem. But perhaps the best way to explain how it is different is to focus on the word “Home.”

Your home is more than a place, it is relationships and the comfort and safety those relationships offer.

For Mrs. Smith, one of those relationships would be the same doctor she has now. Another would be a care manager who checks in frequently with patients with chronic conditions. If Mrs. Smith’s weight increases or she becomes short of breath, the care manager would bring her in for a checkup.

Following the appointment, her doctor might change her prescription. And before she even leaves the building, the practice’s pharmacist would discuss how often and when to take the medication. A follow-up appointment would be scheduled in a week or two.

This new kind of practice is less expensive in the long run because Mrs. Smith avoids emergency department visits – the most expensive type of care. It is better because Mrs. Smith is healthier and gets to stay at home, with friends and family and her dog. It is nicer because Mrs. Smith has relationships with several providers now and she knows that each is looking out for her.

Trying to make our healthcare better at the same time we make it affordable and nicer is very ambitious, but if we do it right, we can rewrite the stories of a lot of Mrs. Smiths, and that’s a goal worth having.