Face-to-Face Relationships Still Matter in a Digital Age: A Call for a 5th C in the Core Tenets of Primary Care

I read this with interest and appreciate the thoughtfulness the authors put into calling out yet another threat to establishing and maintaining meaningful therapeutic relationships with our patients. But it also reminded me of a recent episode the has made me think hard about continuity and contiguity. I mostly retired last year but am still precepting a few times a month. A while back, the faculty member who had inherited most of my practice came into the work room and said, "I just saw one of your old patients, who said you saved his life." I was surprised to hear this and asked who it was. I was even more surprised that his name rang no bells with me. So I opened his chart and discovered I had had exactly 2 visits with him in the previous couple of years. The first was a "virtual" visit, so no contiguity there, and the second was in person. He was struggling with alcohol dependence and severe, uncontrolled hypertension. My colleague reported he was still drinking, but much, much less, and he was now taking his BP meds and monitoring his control. She said he told her I was the first doctor who had listened to him and treated him with respect and our discussion about taking better care of himself had led to the changes.

I was (and am) stunned to hear that I had such an effect on him in just 2 visits, 1 of them remote. But it makes me think that the 5th (or really first) C should be Caring. I always ran late (and apologized virtually every time I entered an exam room), but the patients who put up with that understood that, when I got there, I would listen to them and take whatever time they needed, and I had been doing that with the patients ahead of them. As I have written elsewhere, the modal comment from patients I received when leaving my last 2 jobs was, "Thank you for listening."

There is no care without caring. Our current, fee-for-service-based health care system and electronic billing records (they are NOT about health and we should stop using the term "EHR") place no value on it and reward "efficiency." So why do we have the most expensive health care system in the world with the worst outcomes among industrialized nations???

So how about Caring as the first among 5, or perhaps 6, C's?