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- Page navigation anchor for RE: Does Continuity Still Matter?RE: Does Continuity Still Matter?
When in times of vocational darkness, search for the hidden light. Remember purpose; connect with colleagues; share with patients. And, at least for me, visit the Oracle of Belfast. In these times, fortunately, the oracle has come to us with a warning about a lost pillar. Listen carefully, an abundance of light shines within its words. The future of our personal, generalist craft, of healing, is at risk.
Everywhere, except in health systems, I hear about the loss of continuity with their family physician. My children and grandchild can’t find it anymore. My friends have lost it. Too many younger people never had it. They voice frustration and exasperation about always seeing someone different and no one ever knowing them or able to personalize their care and appreciate the uniqueness of their situation. Health systems respond by mandating greater access because it’s now a world of consumers and they want convenience, not continuity. Thank you, David, for waking us up, for quivering our hearts and souls, and calling us to care for our roots.
Continuity of care, committing to a shared partnership with a patient over time, represents more than a fourth pillar. It functions as the foundation supporting the other three pillars of first contact access, coordination, and comprehensiveness. If we practice continuity, then we find ways to be present with our patients when they are in the hospital, birthing a baby, at the nursing home, in the emergency roo...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Does Continuity MatterRE: Does Continuity Matter
As a family physician in my early fifties who has cared for some of the same patients over 20 years, I wholeheartedly agree with Dr. Loxterkamp’s essay about the lost pillar of continuity. In addition to the issues that he spells out, we also need to address several additional barriers to continuity as a medical community.
As he mentions, the culture of medicine has changed, and much change started at the administrative level. “Back in the day,” hospital and other health care administrators were people who grew up in their communities and remained a part of them. Now, like other industries, administrators bounce around from job to job. People living thousands of miles away make critical healthcare decisions for a community they are not a part of. These “leaders” will never personally feel the repercussions of those decisions, and their effects last longer than the administer does in their job position. As many hospital administrators have little continuity in their communities, that culture has unfortunately permeated down to the physician level.
Another barrier to continuity is due to insurance coverage. Large healthcare systems prioritize the insurance plans tied to their hospital system and don’t contract with all available insurance plans in their community, including Medicaid. As insurance costs increase, employers will understandably change insurance plans for their employees to keep costs down. As a result, when I used to work for a healthcar...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Does Continuity Matter?RE: Does Continuity Matter?
No, Dr. Loxterkamp, continuity does not matter, not to those who run health care (which we as docs have allowed to be run mostly by hospitals), no matter their nice words and slick ads. Nor does access or advocacy matter. I work across the state in the foothills of Maine, where for over 15 years I saw everyone the day they called and was on time for appointments. They saw me and only me. Now I may work (one day a week) in the same system as you. I do acutes and MAT. I work with fabulous people, but in a place so inefficient that, with all sorts of layers of staff, I still see the same number of folks I saw when I did it myself. We cover for the other two practices in the network. One NP has no openings till April. I work for Teladoc also, and no one can ever get an appointment—they may not even have a doc at all. The reasons are the ones you know. Doctors have been silent, and now, employed by complex health care systems, they have no idea why things went wrong. They are so shielded. In my former system, a recent survey said 62% of docs were indifferent. We have let hospitals systems make processes difficult. We have put up with multiple websites to do referrals—often to people WE as PCPs are getting paid; we cannot be gatekeepers to XRT for breast cancer, but I must "refer" patients on my dime. Doctors are unwilling to actually DO anything, even if they knew what they could do. Some of us write a bit, but we are watching a society in decline, a pretty little pla...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: continuity of careRE: continuity of care
I am in my 42nd year of practice. When I was in my residency in the late '70s, we were told that our great virtue in family medicine was in fact continuity of care and knowing all members in the family unit which would benefit our treatment of all. I have had the honor of taking care of newborns and their at time their children. I have been able to take care of grandparents, parents, children and grandchildren. We are jacks of all trades but masters of continuity and the understanding that comes from the care of all in the family. I pray that future generations of our specialty will have the same privilege and will understand the value of it!
Competing Interests: None declared.