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Building your medical home


Aristotle said that “The whole is greater than the sum of its parts.” In other words, when individual parts are connected together to form one entity, they are worth more than if the parts were separated.

When it comes to health care, connecting all the different components of care can help create more positive outcomes for patients. Consider a wheel where the spokes connect at the center, with the patient as the hub of the wheel. The health care team represents the adjoining spokes, providing support for forward motion towards optimal health. This collaborative, patient-centered approach then creates a “medical home.” A medical home is a person’s network of providers, starting with a primary care provider. Physicians, physician assistants and nurse practitioners often serve as primary care providers. The primary care provider ensures specialists are involved, when needed, to provide ongoing support to the patient. Patients with complex medical needs often rely on a diverse team of providers from multiple disciplines—physicians, nurses, therapists, pharmacists, social workers, dieticians—to meet their needs.

This network of medical professionals is easily connected in an urban area, but what about more rural areas like Montana when doctors and patients may be hundreds of miles apart? Long distances can certainly pose some challenges to health care access, but it can also help to drive creative solutions. For example, patients that may not have a local specialist in their community can often be seen by telemedicine (remote and/or distant access to a provider via online or other means). This virtual doctor visit allows the patient and their family to stay in their community while still receiving the specialized care they require. Telemedicine also promotes better continuity of care because providers many miles apart are able to collaborate and communicate in real-time about a patient’s needs. Technology has been a significant boost to health care, serving as a spoke to connect providers and patients in more rural locales like Montana.

While technology has improved access to health care in major ways, the responsibility of being an engaged patient still rests on the shoulders of each individual. One way to be a proactive and engaged patient is to create your medical home before a health crisis occurs. Identifying your primary care provider before you fall ill is a great first step. Knowing your family’s medical history can also clue you in to potential ailments. If your mother and grandmother battled breast cancer, for example, it’s a wise choice to get your annual mammogram screenings or consider genetic testing.

Genetics can play an important role in predicting certain health risks. There are numerous cases where knowledge of our genetic traits informs medical choices or care. Angelina Jolie is a well-known instance where family history impacted her choices. Jolie tested positive for BRCA gene mutations, which essentially means she was at very high risk for breast/ovarian cancer. Her mother died from ovarian cancer when Jolie was young. As a result of this genetic testing, Jolie was better-informed to make decisions on her own timeline versus waiting for a possible cancer diagnosis in the future. Each choice is very personal, but she decided to proactively undergo a double mastectomy and removal of both ovaries (oophorectomy) to reduce her risk of developing cancer.

The spike of mail-in DNA tests also demonstrates a powerful desire people have to be proactive about their health. However, before you drop cash on a home DNA test, consider working within your medical home to obtain this important information. In this manner, your results can be paired with useful medical information and options. This is yet another example where technology has added another spoke in the health care wheel for connecting patients and providers in new and interesting ways.

The Montana Perinatal Center offers genetic counseling for prenatal, pediatric and adult genetic diseases. Genetic counselors are health care professionals who can help support your medical home. The wait time for genetic counseling is typically only a few weeks and often it is a no-cost service to the patient. Genetic testing is also recommended as a tool for individuals with childhood development disorders, including autism spectrum disorder, developmental delays, and intellectual disability. Genetic counselors are experts in identifying the correct test and the right laboratory to ensure cost is not a barrier to obtaining valuable information that the patient or family is seeking. Find out more about genetic counseling at krh.org/MontanaPerinatalCenter.


Co-authored by Debra Guinn, MD, maternal-fetal specialist, Montana Perinatal Center

Maternal-fetal medicine specialist Debra Guinn, MD, joined Kalispell Regional Healthcare in June 2015, opening the Montana Perinatal Center to care for mothers with high-risk pregnancies and perform diagnostic ultrasound, prenatal diagnosis and fetal therapy. She works together with obstetrical providers, neonatologists, pediatricians, nurses and anesthesiologists to develop an optimal plan of care to promote the health and well-being of both mothers and unborn children. Dr. Guinn serves as the medical director for Kalispell Regional Medical Center’s maternal and fetal medicine program.

Co-authored by Tessa Pitman, MS, CGC, genetic counselor, Montana Perinatal Center

Tessa Pitman, MS, CGC, is a certified genetic counselor based out of the Montana Perinatal Center at Kalispell Regional Medical Center. She is passionate about providing patient-centered care to rural Montana and empowering patients to make informed decisions about genetic testing as it pertains to their values and medical care. She provides genetic counseling services at Kalispell Regional Healthcare to pediatric and adult patients for a broad range of genetic indications and concerns.