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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Re: Very Long Term Continuity
Very Long Term Continuity
"The Real Face of Continuity"
Continuity and the Future of Family Medicine
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John W. Saultz, Portland, Oregon Oregon Health and Science University
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I was surprised in doing the review by how little research has been reported regarding long term doctor-patient relationships. Such long term relationships are probably less common in the academic settings where research has traditionally taken place. It is also not the sort of question that would occur to non-primary care investigators. At the end of the process of reading all of these papers, I was left with the following questions about this: 1. What are the key events that occur early in such a relationship that promote a bonding between doctor and patient? 2. Are long-term doctor patient relationships more likely between doctors and patients who have other long term relationships in their lives? 3. While doctors and patients may like long term relationships, do such relationships actually improve care in any measurable way? 4. Would patients who aren't in long term relationships be more satisfied or get better care if they were put into such a relationship? 5. Can we learn something about long term relationships by studying how doctor-patient relationships end? Perhaps a long term relationship is one that hasn't had a reason to end! Competing interests: None declared |
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Lucy M. Candib, Worcester, MA USA Family Physician, Family Health Center of Worcester and U-Mass Medical School
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I concur with Bruce Bagley. Much of the research around continuity has looked at relationships of relatively short duration. None have examined the implications of Very Long Term Continuity, by which I mean 20+ years of doctor-patient relationship. And despite our nomenclature, no one is looking at the fact that in the course of this kind of continuity we have generational connections with multiple levels of a family: delivering a baby and 2 decades later delivering her baby, as Bruce pointed out. So the continuity is not just 1:1 between doctor and patient, but rather to a whole family. We have not investigated this kind of continuity at all. When we get around to looking at this, I suspect we will find that it not only matters deeply to those of us who do it, but it is also deeply important to those complex multigenerational families we care for. Competing interests: None declared |
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Bruce Bagley, Albany, New York Family Physician
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After more than a quarter of a century of full service family practice, I understand continuity in a way that is untouched by the literature. It is about caring for friends, not just patients. It is about diagnosing pregnancy, delivering the baby and watching that wonderful creation of God grow into a fine human being with family, friends, dreams and hopes of her own. Then delivering her baby. Continuity is such an inadequate word to describe helping a friend (patient) as he faces death, to deal with pain, loss and unresolved family conflicts. The literature fails to describe what family physicians provide for their patients every day. It is about trust. It is about connecting. It is about knowing the real cause of the "dis-ease." It is about understanding people and providing simple explanations. I have been blessed in so many ways, but most importantly, thank God, I am a family physician. Bruce Bagley, M.D. Competing interests: None declared |
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Larry A Green, Washington, D.C., USA Physician
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Dr. Saultz deserves our thanks for his work and thoughtfulness concerning continuity. His formulation of continuity into a three- component hierarchy seems useful and stimulating, providing more than just the appearance of clarity. The emerging report of the Future of Family Medicine Project (FFM) has perhaps unwittingly reflected his formulation. Even though continuity is identified as a core value of family medicine by this project's leadership, it is not greatly emphasized as an isolated "thing." Yet, the collective effort of the FFM is at this point emphasizing the great importance to the future of family medicine of the electronic health record (aligning with Saultz's informational level 1 hierarchy), a medical home for all (aligning with Saultz's level 2 hierarchy) and a fundamental identity of family physicians needing to help individual people (aligning with Saultz's level 3 hierarchy). This concordance of contemporary debate and assessment with Saultz's historical review feels solid and substantial, not a frail, misty-eyed yearning for some idealized past. As "new model family medicine" emerges during the next decade, it is important that clear thinking guide measurement of the existence and effects of continuity. If the forecast additional work is as useful as this formulation, immediate progress should be at hand. Competing interests: None declared |
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