Patient-Physician Shared Experiences and Value Patients Place on Continuity of Care

Previous research on continuity of care has made the implicit assumption that all relationships between doctors and patients are equal, essentially a matter of knowledge transfer. The longer the relationship between the doctor and patient, the more knowledge the doctor will acquire about the patient, and may therefore deliver better care. Those of us who actually care for patients know that this is poppycock. Doctor patient relationships come in all flavors and qualities, and are dependent on the personhood of both doctor and patient. In many ways the doctor is the therapy, and how he or she and the patient connect to each other determines the effectiveness of treatment, particularly of chronic illness.[1]

Policy makers, managed care companies and employers, however, view doctors as interchangeable (except a few who simply need a knowledge infusion). Continuity of knowledge is valued (hence the emphasis on electronic medical records) but not continuity of relationship. One study documented that even in 1997, 25% of patients in the study population had to change physicians in one year because of changes in health insurance plans.[2]

The study by Mainous, et al, is a quantitative breath of fresh air on this topic. The authors have made creative use of the DOPC data to demonstrate the complexity of how shared experiences between doctors and patients influence, and are influenced by duration of relationship, chronic illness, and patients’ value of continuity. They use sophisticated and rigorous analytic methods to support their conclusions.

As with all good research, this study generates more questions than it answers. What are the determinants of an effective doctor-patient relationship? How does such a relationship affect patient outcomes in chronic illness? What is the best way to define outcomes in chronic illness? How do scientific knowledge and personal knowledge interact?

Answering these questions will require the best efforts of both qualitative and quantitative researchers. Dr. Mainous and his colleagues have set us on the right path.

1. Cassell, E.J., The nature of suffering and the goals of medicine. 2nd ed. 2004, New York: Oxford University Press. xx, 313 p.

2. Flocke, S.A., K.C. Stange, and S.J. Zyzanski, The impact of insurance type and forced discontinuity on the delivery of primary care. J Fam Pract, 1997. 45(2): p. 129-35.

Competing interests:   None declared