Family Medicine Matters Blog

The OCFP Blog discusses current topics and invites members to share their perspectives and ideas, and engage in a dialogue.

Continuity Matters

September 15, 2016

We often hear about how patients love their family doctors and in May I received a message through the OCFP inbox from a patient named Tracy, who wrote to say, “My family doctor deserves a hero award”. She told us about Dr. Kirsh and his longstanding commitment to the relationship he had with her father, her brothers, her children and herself.  Relationships founded on trust, Dr. Kirsh’s availability to them and a commitment to caring through difficult diagnoses and difficult life situations made Dr. Kirsh a hero her eyes.

 

Continuity of the patient-physician relationship is one of the defining pillars of the discipline of family medicine, however it is only one facet. In the context of our modern health-care system what does continuity of care really mean?

 

Ian McWhinney said: “The essence of general practice is an unconditional and open-ended commitment to one’s patients. We define ourselves in terms of this relationship.”[i]

 

Family medicine is not merely a series of illness related transactions, but rather the weaving of a narrative between two people as the story of a person and their health evolves over time. It is continuity of that relationship over time that allows the narrative to develop, the person seeking care to be understood, and sometimes for healing - not just treatment – to occur.

 

As the CPSO and others have identified in their work on continuity of care, test followup and patient safety, there is a critical importance to understanding that isolated bits of information must be seen as more than just bits of information, but rather as potential turning points in the story that must be understood and followed to ensure the best possible outcomes for patients. 

 

As we think about what the continuity of relationship (and not just continuity of practice setting) means to our patients and to the health-care system, we need to challenge ourselves to ask some important questions with a lens on continuity. We need to be able to ask and answer these kinds of questions for ourselves: 

  • Can I provide reasonable (or even excellent) continuity of care to the practice that I have?
  • Does my roster size match the hours that I can see patients?
  • Does the complexity of patients I see uphold the commitment to the relationship that my patients expect of their family physician?
  • If I work in a family health team or focused practice, how do I ensure that my practice is organized to meet the needs of patients?
  • How do we foster continuity of care when a patient’s point of contact is a team and not a single person?
  • If I work with other inter-professional health providers, how do we ensure that each of us is working to our full scope of practice while maintaining continuity?
  • If we sacrifice the one-to-one relationship with our patients, does it mean that we are sacrificing the quality of care?

 

These are just some of the questions we, as family physicians, are grappling with as our health-care system changes. Patients are also asking about how better to establish and maintain a relationship with “my” family physician, and not just be “rostered” to a practice.

 

With what I anticipate was more intuition than evidence, 60 years ago when the discipline of family medicine was defined, those who founded the discipline understood that the relationships that we have with our patients are key to the work that we do. In July, the Alberta group Toward Optimized Practice helped us to move further beyond our collective intuition about continuity in primary care. The highlights of the evidence that has been compiled should be part of every family physician’s knowledge base because it is core to the value of the work that we do – for individual patients, for populations and for health system sustainability.

 

The evidence summary, in infographic form, highlights that in most studies continuity of care improved health outcomes, reduced mortality, improved satisfaction, improved adherence to recommended treatment, improved preventive care uptake, improved health overall, decreased health system utilization and decreased cost.

 

Our health-care system is increasingly looking at how to provide high-quality care to individual patients, improve the health of whole populations and simultaneously manage costs. Improving continuity of care with our patients, in keeping with the fundamental commitment of family medicine, may be one of the ways that we can help to accomplish all three.

 


[i] McWhinney IR. “The essence of general practice”. In: Lakhani M, editor. A Celebration of General Practice. Abingdon, Engl: Radcliffe Medical Press; 2003.

 

2 comments

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  1. Sarah Newbery | Sep 20, 2016

    Thanks so much Dr. Payne for this feedback.  Although you have identified yourself as "one of the old doctors", this is part of what we are hearing from residents as well... that they feel that when they get down to the relationship, they feel that care is better and they feel more satisfied with their role.

    Thanks again for your feedback.

    Sarah

  2. John C Payne | Sep 17, 2016

    Dear Dr. Newbery

    As one of the old doctors I would like to congratulate you on understanding the factors which are competing with what I know is the essence of " good doctoring" as Lynn Carmichael described it.

    Ian McWhinney always spoke of the importance of "the relationship".

    Focused and certified extra proficiency started things. Then came Evidence based medicine, the EHR " the heart of family medicine". Then the huge financial inducement of capitated FHT's. I was quoted 30% more money to continue doing what I was doing.

    Because of these challenges I think Family Medicine is at risk of failing.

    Please don't let go of this challenge.

    Thank you

    John C Payne

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