Continuity of Care Heals the Wounded and Builds Trust

By Col. Charles C. Engel
Director, Deployment Health Clinical Center, WRAMC

This post is republished from The Military Health System Blog.

What do you think is the most important part of your medical care? Insurance coverage? Cancer screening? The right diagnosis? A particular diagnostic test? The right medicine? Time to ask medicine? These are all important considerations to be sure. A growing number of doctors and patients point to something called “continuity of care” as the single most important ingredient in your medical care. What exactly is this elusive thing with your doctor called “continuity”? Well, there are many parts to continuity of care, but some are pretty central. Most people find that the basics of continuity of care are so simple that they amount to common sense. But alas! We often lament just how uncommon that common sense is, and many will undoubtedly feel this is no exception to the rule.

Here are some signs that you have good continuity:

• You have one main (primary care) provider or doctor.

• You know who your primary care doctor is and think of him or her as "my doctor."

• Your doctor thinks of you as "my patient."

• Your doctor has a good sense of your health and tracks it.

• Your doctor makes an effort to understand what’s important to you.

• Your doctor also takes care of others in your immediate family.

• You usually see the same doctor when you come in for care.

• When you see the doctor, you find out about the planned visit before you leave.

• When your doctor orders a test, you are sure to hear the result.

You get the idea. Continuity works in shades rather than in black and white. I suspect that few people can report that all of the above describe the medical care that they are receiving. I suspect that more people than we want to admit would say that few or even none of them describe the health care they receive.

Why is continuity of care such an important thing? How does it make a difference? There are those doctors and (fewer) patients out there who think that too much is made of it. These people tend to focus more on the “gee-whiz” scientific and technical side of care. But if you tend to see it that way, stop and think. Studies of continuity tell us that lack of continuity is associated with doctor and patient errors. High continuity leads to greater trust and confidence in your doctor, making it more likely that you will follow the medical advice you receive, and take prescribed medicines. Much of medical care is a process of trial and error. It takes continuity to see such a process through to a fast completion. Indeed, it takes continuity to check to assess whether treatment is working and selecting what to try next if the first try hasn’t helped.

Do you have good continuity of care? Perhaps you have some stories from your own care that show how good continuity led to a good outcome that you believe would not have happened without that continuity. If so, tell us about it. Tell us what you think about “continuity of care” and why it is or isn’t important to you.

Engel is also an associate professor of psychiatry at the Uniformed Services University of the Health Sciences.