The family doctor – old-fashioned or the key to a healthy future? (Part 1)

The Family Doctor

The Family Doctor in 1948. Source: Nedhardy.com

A few years ago, when I was boarding a plane I picked up The Times newspaper and noticed a big headline stating: ‘The family doctor is going out of fashion’. In the article journalist Matthew Parris explained why young people prefer to go to the emergency department. I kept the article as I thought it would be a great blog topic, but for some reason I forgot about it – until something jolted my memory.

Last month I had the pleasure of meeting with the Board of Health Consumers Queensland. I enjoy conversations with consumer representatives as I always learn something, even though these exchanges are usually slightly confronting. One of the topics we touched on was continuity of care, or better, the perceived lack thereof in general practice by consumers. During the drive back home to the Sunshine Coast I suddenly remembered the article in The Times.

In 2013 Parris wrote: “Very gradually the era of the personal physician is drawing to a close.” He said he noticed a trend in the UK where younger, busier people were going directly to specialist accident & emergency departments and argued that they don’t want a local GP because working men and women in a hurry will be attracted to a place where they can walk from one room to another and access the specialism they need.

So, I wondered, is the family doctor who provides ongoing care a thing of the past? Am I really a dying breed – the last of the Mohicans?

What exactly is continuity of care?

In primary care literature continuity is often described as the relationship between a single practitioner and a patient that extends beyond specific episodes of illness or disease. To confuse the situation other terms are used synonymously, such as ‘care coordination’, ‘integration’, ‘care planning’, ‘case management’ and ‘discharge planning’. On top of that the experience of continuity may be different for the patient and the health practitioner, adding to even more misunderstandings.

Continuity is how individual patients experience integration and coordination of care.

The authors of an article in the BMJ titled ‘Continuity of care: a multidisciplinary review’ said that continuity is not an attribute of practitioners or organisations. They defined continuity as the way in which individual patients experience integration of services and coordination. And also: “In family medicine, continuity is different from coordination of care, although better coordination follows from continuity. By contrast, a trade-off is required between accessibility of healthcare providers and continuity.”

There are three types of continuity of care:

  1. Informational continuity: The use of information on past events and personal circumstances to make current care appropriate for each individual
  2. Management continuity: A consistent and coherent approach to the management of a health condition that is responsive to a patient’s changing needs
  3. Relational continuity: An ongoing therapeutic relationship between a patient and one or more providers.

Continuity is more than just sending a message to another health practitioner, or uploading a piece of information to an e-health database. Understanding of individual patients’ preferences, values, background and circumstances cannot always be captured in health records; health providers who have a longstanding relationship with their patients often have this information in their heads.

“Poor continuity gives rise to high risk medicine

In 2010 Dr Frank Jones wrote in Medicus: “Poor continuity gives rise to high risk medicine. Ideally continuity should be personal and longitudinal – the essence of the traditional general practitioner. However the very concept of continuity gets more complicated nowadays. How does it apply to single-handed GPs or to group practices?”

Indeed, continuity of care exceeds disciplinary and organisational boundaries. The Royal Australian College of General Practitioners describes continuity of care as “the situation where patients experience an episode of care as complete, or consistent, or seamless even if it is provided in a number of different consultations by different providers.”

The benefits of continuity

There is abundant evidence that continuity in primary care results in improved patient health outcomes and satisfaction. Evidence also indicates that primary care (in contrast to specialty care) is associated with a more equitable distribution of health.

GPs often manage up to 4 problems per visit, which is of course more efficient than walking ‘from one room to another’ in an emergency department or hospital outpatient department. Overall, primary care is associated with lower total costs of health services.

Looking at the primary care reform processes that are under way in Australia, it is not unlikely that the multidisciplinary general practice team will be the key component in the care for people with chronic and complex health conditions.

In part 2 I will discuss the six methods GPs use to improve our health, according to world-renowned primary care researcher Professor Barbara Starfield, and why primary care plays an important role in a sustainable health system.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.
Is family medicine going out of fashion?

Is the family doctor going out of fashion? Not really. Source: The Times

5 thoughts on “The family doctor – old-fashioned or the key to a healthy future? (Part 1)

  1. Reblogged this on karenpriceblog and commented:

    Continuity of care. What a great Topic Edwin Kruys. Worth adding to the eclectic mix on this blog of the importance of a strong primary health care. However what does that even mean? It is such a complex part of the health system which interfaces every other aspect g the health system but which is hard to describe.
    Like many GPs I think the fact that it is both hard to describe and hard to see how important this central role is that GPs and GP specialty services are often undervalued.
    Yet there is increasing academic research which points again and again to the centrality and efficiency of this part of the health service.
    When I took over a very old rundown practice in 1998 my octogenarian senior retiring partner told me something that has always resonated. This was from a man who was a Polish Jew, whose family had been partly lost in the Holicaust and who had fought on the Russian front. He emigrated to Australia and as a qualified rehab specialist from Poland worked in a hospital plaster cast department in the basement. One of the orthopaedic surgeons noted the exemplary work and sponsored him to get recognition for his qualifications and exam. This now much older Polish man with his OAM (order of Australia medal) leaned back in his chair his blue eyes hooded and a shock of white hair matching his buttoned up white coat. He said “Karen, life is all about relationships.”
    General Practice reflects that life. General Practice is about relationships. Very powerful and not easily measured. Too easily overlooked.
    RIP dear Fred. And thanks for the reminder too Ed Kruys of the special nature of Primary Care.

    Like

  2. Pingback: The family doctor – old-fashioned or the key to a healthy future? (Part 2) | Doctor's bag

  3. Hi Ed, I once read a letter – I think it was in the MJA in the early 80s – from a GP. His father and grandfather had also been GPs. I don’t have the numbers right but the gist of it was that his grandfather in the 1920s/30s saw about 50 patients per week, 20% or so as home visits (sometimes taking a day or two to do) and he earned 3-4 times average weekly earnings. His father, as a GP in the 50s, saw about 100 patients per week about 50/50 home visits and surgery visits and earned 2-3 times average weekly earnings. He himself in the 70s saw about 200 per week, mostly in the surgery and earned 1.5-2 times average weekly earnings. You pictures of the 1948 GP walking with his bag reminded me of this old letter.
    John

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