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Continuity of Care Makes a Difference

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Increased continuity of care lowers patient mortality according to a study published in BMJ Open, a peer-reviewed medical journal. Patients across all demographics had lower mortality when continued care was provided by the same primary care physician or specialist. Even though medicine has undergone substantial advances in the use of technology to detect and treat disease, the physician patient relationship  remains important. Continuity of care means more that just patient satisfaction - it provides benefits that save lives.

Continuity of care creates a better interpersonal bond between the physician and patient that encourages disclosure. Patients perceive a doctor they see regularly as more responsive. They are more willing to disclose more information, which helps the physician tailor care to the needs of the patient. Continuity of care has been considered a feature of the practice of medical generalists and is often part of their job descriptions. This recent study found that continuity also reduced mortality for care provided by specialist physicians, and surgeons. Unfortunately, doctors tend to overestimate their effectiveness when consulting with patients they do not know and underestimate their effectiveness when consulting with patients they know.

One of the benefits of continuity of care the article does not address is how continuity gives the physician a "feel" for the patient over time. Subtle changes in a patient's demeanor and on physical examination are only detectable when the same physician has seen and followed the same patient - whether over a period of days during a critical illness or over months when treating chronic diseases. Past interactions provide a reference point for the physician to be able to detect subtler clinical changes in a patient and provide intervention earlier. Subtle changes on examination of an acute abdomen over time can be best appreciated by the same hand of the same physician repeating the same examination. Subtle changes in a patient's demeanor can best be appreciated by the same physician seeing the same patient. Diagnostic tests provide the science to medicine but do not provide the feel for the patient that a physician gets when there is continuity of care. The feel for the patient makes medicine an art as well as a science.

The fact that continuity of care provides for better outcomes and is associated with lower mortality should be no surprise. Older physicians know this all too well. Unfortunately, modern medicine has moved in the direction of more fragmentation, not less. Solo practitioners are going the way of the dodo. While modern medicine may increase the delivery of care, it does so at the expense of the patient-physician relationship. Continuity of care needs to be maintained for the physical and mental well-being of patients.

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