Towards a New Understanding of Provider Continuity

Buetow makes an important conceptual leap in moving away from the usual clinician-centric perspective of continuity towards one that includes patients and those that accompany them. Does family medicine require a “new dictionary” as he claims? I would venture a resolute “yes”, since, as he points out, our current approach, “devalues contributions from patients and their informal caregivers and limits our understanding of key concepts, their effects, and health policies for achieving them.” Have previous authors such as Starfield and Schers not gone far enough in obtaining patients views on personal continuity? I am not sure. Buetow’s concept of patients and those who accompany them as “principle health care workers” and “coproducers” may be true in the interactional sense and in terms of narrative negotiation, but it ignores the power and therapeutic differentials that exist in medicine (and that likely includes Western, non-Western, traditional and complementary- alternative versions).

Buetow might agree with an approach that, while being patient- centric, allows for clearer role differentiation. I might suggest that Continuity could be defined from a patient perspective, in a process of separately elucidating personal meanings of the term in regard to one’s health care provider(s) and one’s personal attendees (in Buetow’s words, “…those who attend with, or for, the patients during successive visits.” Defining the inclusivity of the scope or frame for health care provider(s) and attendees would be a second task. For some, health care provider(s) would be a single, personal physician, for others this might entail a group practice, health center, or even a whole profession. Similarly, attendees/caregivers might be bracketed to include only a spouse or partner, members of the nuclear family, or expanded to include a whole community, sect, or religion. I can attest to observed cases of all of these, and examples abound from our local and international experiences. The discussion that Buetow has taken up is important, as it has ramifications for research, education, and policy. I hope that it becomes takes us to a new conceptualization and dictionary in the process!

Competing interests:   None declared