There’s a wonderful video that illustrates the point I’m making this week. You can see it here.
It is assumed that continuity of care is a good thing. That if you consult the same doctor every time then you will benefit with better health. We all have relatives who insist on seeing the same doctor every time. No one but Dr. X will do. Yet doctor X has all sorts of interesting approaches to their problems and despite knowing Aunt Mildred for years hasn’t twigged that her latest symptoms may be a manifestations of some family drama. She might suddenly be more bothered about her aching hip because Uncle John is making her miserable or making her carry the shopping on their visits to the supermarket.
So, is there strong evidence that people who consult the same doctor at every visit are:
- Less likely to be prescribed inappropriate drugs or have unnecessary tests?- Maybe.
- More likely to have symptoms of life limiting illness recognised early?- Not really.
- More likely to be counselled about poor lifestyle choices addressed?- Maybe.
- More likely to be screened for chronic illness? – Maybe
- More likely to be immunised?- Maybe.
- More likely to have better outcomes from chronic illness?- Maybe
The evidence is equivocal at best. Even the most ardent supporters of continuity conclude that there is ‘lots more research needed’.
So what does that tell us?
Perhaps it suggests that simply because people choose to see different doctors does not necessarily mean they are opting for, or receiving, inferior care.
When it comes to test ordering ‘walk-in’ patients are not necessarily after tests and there is some evidence that those doctors who order tests in the hope of ‘satisfying’ the patient are misguided.
There is lots of evidence that ‘continuity of care’ increases trust in a doctor. As per the example of Aunt Mildred. But there is no evidence that Aunt Mildred will be better off trusting her doctor because ‘trust’ ( which isn’t consistently defined) does not guarantee better outcomes. If Aunt Mildred attends here GP presenting with symptoms of bony metastases and is referred for urgent investigation because her GP recognises the clinical signs then she will have been well served regardless of whether she attends Dr. X, Dr. Y or someone at another practice. The point is one of them should spot the moonwalking bear.
Picture by torbakhopper