(Originally posted on Feb 11, 2021)
Continuity of Care is a term used in medicine to describe a way of delivering healthcare to a patient. From a patient’s point of view, continuity can mean having one doctor throughout their lives who act as ‘home’ or ‘base’, where the patient reports back on every aspect of their lives, including when they have seen another healthcare practitioner for further management. From a health system perspective, continuity of care refers to the patient’s doctors notes being available to any doctor who sees the patient or by effectively passing on the care of a patient to a healthcare practitioner who can meet the needs of the patient better.
Research shows that while these definitions and practices continue to change over time, having one doctor manage a person’s health over time has numerous benefits for the doctor, the patient and the health system. Clinical studies done in Norway, USA and UK all reveal remarkable results.
From a patient’s perspective, continuity of care allows for:
Increased patient satisfaction
Patient’s feel more in control of their health
Their health is better managed as outcomes from illnesses are better
Less testing is required
Less need for medication
Patients trust their doctor more, which leads to a person being able to watch and wait or try alternative methods first rather than using medicines at every visit - also known as ‘expectant management’
From the doctor’s perspective:
Doctor’s have a greater sense of job satisfaction
But with a greater sense of investment, comes the flip side of increase personal commitment and time to their work (which plays heavily on the doctor’s wellbeing)
And from a health system's perspective:
Burden of healthcare costs decrease - needing less laboratory testing and less use of medications
The evidence is clear on the need for greater continuity of patient care, but as a doctor I want to share a personal experience with you so you can see the impact first hand. When I graduated from medical school in 2007, my mother chose me as her doctor. Over the years I felt extremely proud and satisfied when I heard my mother say “Farah is my doctor and I trust her, everything she recommends for me works.” This made all my years of personal and financial sacrifice worth it. What she said, though, wasn’t entirely true because no doctor is always immediately right when a problem arises. That is a fact. But the two significant points from this were: 1. Mom trusted me, and when something didn’t work, she came back to me and we tried something else. We practiced ‘expectant management’ and only did tests when needed. 2. Because her symptoms and complaints always resolved, she had the perception that I was always right.
Fast forwarding to January 2021 and trying not to break patient confidentiality here; my mom is an active, strong willed, retired ‘elder’ who was generally well. But one day everything changed, she got very ill overnight and was taken to hospital by an ambulance. I was in contact with the doctors at home who were taking care of her, via phone. This is where having been my mom’s doctor for many years added value. As her healthcare advocate, I was able to share my perspective and concerns from a medical standpoint with the doctors at the hospital who were seeing her for the first time. In my last blog post, I spoke about the importance of perspective when a doctor arrives at the most likely diagnosis. You can read more here.
While the doctors explained their differential diagnoses to me, having known her full history for many years, my thinking was entirely different. After expressing my concerns to all of her managing doctors, thankfully, the correct complication was diagnosed and treated. Ten days later my mom was fortunate enough to walk out of hospital after facing a near death experience. This also highlights another skill that is important for any healthcare professional and that is their ability to effectively listen to the concerns of a patient or their advocate.
This situation changed my life and I am more committed now to the added value of continuity of care, including the practice of a ‘whole-system’ approach to wellbeing. This is only one personal story, if share those about my grandmother who is also still alive today, I think my point will be driven home. Will save that for another time.
Doctor’s don’t save lives by their own will, but there are a multitude of factors including divine control that allow circumstances to occur. Having my mom blessed with doctors who were willing to listen to my concerns even though I am on the other side of the world, was not just coincidence to me.
My take-home messages, there is significant value in Continuity of Care as it can save lives and save costs and Telehealth definitely has a role in the future of health systems to allow greater communication between patients and their doctors and between referring doctors to provide the best care to our patients. If you have any questions about this issue, please reach out to us through our website www.noorcorporatehealth.com.
Sudhakar-Krishnan V, Rudolf MC. How important is continuity of care? Arch Dis Child. 2007 May;92(5):381-3. doi: 10.1136/adc.2006.099853. PMID: 17449521; PMCID: PMC2083711.
Gulliford M, Naithani S, Morgan M. What is 'continuity of care'? J Health Serv Res Policy. 2006 Oct;11(4):248-50. doi: 10.1258/135581906778476490. PMID: 17018200.