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Monday Jul 09, 2018

FPs See How Much Continuity of Care Matters

My patient Rick came to see me this spring for what was supposed to be a routine annual visit. He initially didn't present any serious complaints, but he mentioned in passing that he had skipped hunting during turkey season.

Here I am with a patient at my clinic in my hometown, where I've practiced since 1982. Family physicians get to know our patients and their families over time, which enables us to know their histories, their social determinants of health and the complexity of their conditions.

Rick is an active man in his 40s and an avid hunter. Voluntarily missing turkey season raised some obvious questions, so I pursued the issue. He told me that he had felt fatigued recently and that he had experienced shortness of breath when walking up hills.

I asked him about chest pain and other heart symptoms, but he had none. Another doctor -- someone who hadn't known the patient and his family for more than two decades -- might have begun a different work-up and evaluation. That physician may have eventually made the right diagnosis but could also have chased a lot of rabbits before making the correct call.

I had been the family's physician years ago when Rick's father died at a young age because of a heart attack. And although he isn't my patient, I also knew that Rick's brother had undergone heart bypass surgery.

My antenna was raised.

I sent Rick to a cardiologist for further study, which revealed a significant blockage in his left main coronary artery, commonly known as "the widowmaker," and the need for bypass surgery.

Rick hadn't come to me complaining of symptoms specific to heart disease, but I knew him and his family well enough to know that something wasn't right. We likely averted the kind of premature, sudden death that claimed his father.

If Rick's shortness of breath had led him to an urgent care or retail clinic, would his outcome have been the same?

Studies have shown that continuity of care increases patient satisfaction, uptake of recommended preventive services and adherence to medical advice, and it decreases hospitalizations and emergency department visits. A recent analysis of 22 studies in BMJ(bmjopen.bmj.com) found what many of us already suspected -- that continuity of care also decreases mortality.

Continuity is one of the hallmarks of primary care. We get to know our patients and their families over time, which builds trust and understanding. We know our patients' histories, their social determinants of health and the complexity of their conditions.

We also know when something varies from baseline, and -- just as in Rick's case -- that can make all the difference.

John Meigs, M.D., is Board chair of the AAFP.

Posted at 04:33PM Jul 09, 2018 by John Meigs, M.D.

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