A riff on continuity of care: How it helps to personalise realistic medicine and makes patients agents of improvement.

A year ago, I worked for three days in Pollok, at the Peat Road Medical Practice. I made a fairly amateur video of my experience, but the points I made at the end still feel really important.

I can still recall the faces of the patients that I saw in those three days, and wonder what happened to them. I didn’t have the luxury of reviewing them, of speaking to the wider team over time to see how they were doing. I wondered how it felt for them, not knowing who would see them next, or who would steer them through the system to better health.

I have the luxury of having worked in the same practice for over 25 years, and even if I don’t see a patient often, I know their back story, and if they want to see me, they know I’ll be there, and that I know the local health system intimately. This long-term relationship is based on trust and shared knowledge.

A systematic review of the impact of continuity of care was published in the BMJ last year, examining the link between continuity and health outcomes. It concluded that higher levels of continuity of care are associated with lower mortality rates, no matter the clinical system or cultural boundaries.

The articles that this analysis was based on were heterogeneous, and the authors comment on how hard it was to compare themes and outcomes. This said, I would like to have seen the article also discuss whether continuity of care has an impact on choice and management of risk. My own experience tells me that when the patient and I know and trust each other, I can take conversations further, and the patient is more able to tell me what they want from their care. Continuity of care can give us the freedom to decide to do nothing. It empowers patients to set their own health agenda.

My theory: Continuity of care promotes realistic medicine. It supports patient-centred discussions, and coaches patients into being the best advocates for their own health. On a large scale, it supports effective health care, and drives improvement by taking the needs of patients to design better systems.