by BelandaJuly 30, 2018

If you would like someone to defend you in a court case, would you keep switching lawyers? If you would like a stable, nurturing marriage, would you repeatedly get divorced and re-married? If you would like a winning team or company, would you hire only interim coaches or CEOs?

If you answered “no” to any of the above, then you can see why the findings from a recently published study in BMJ Open are not surprising. Researchers from St Leonard’s Practice (Denis J. Pereira Gray, Kate Sidaway-Lee, and Eleanor White), University of Exeter (Angus Thorne), and the University of Manchester (Philip H Evans) in the United Kingdom conducted a systematic review of studies that measured the association between continuity of medical care and the risk of death. In other words, are people who stick with the same doctor more or less likely to die earlier? They found 22 studies in the MEDLINE, Embase and the Web of Science databases from 1996 to 2017 that matched their search criteria. According to the authors, the studies were “from nine countries with very different cultures and health systems.” Nearly all (18) of the studies showed that increased continuity of care (i.e., seeing the same doctor over time) was associated with statistically significant reductions in mortality.

Of course, while the observational studies found in the systematic review may show associations, they can’t prove cause-and-effect. Other issues such as having an unstable job or personal life situation could cause a patient to both switch doctors frequently and have a higher risk of death (earlier death, that is, since no one has found a way to avoid death all together). Also, a patient may be switching doctors frequently because he or she can’t find a good one. Plus, systematic reviews are basically mash-ups of studies of varying quality and circumstances.


Television shows such as Chicago Med don’t show patients switching doctors episode to episode. But does this match the real health system? Pictured: (l-r) Norma Kuhling as Ava Bekker, Ato Essandoh as Isidore Latham, Colin Donnell as Connor Rhodes (Photo by: Elizabeth Sisson/NBC/NBCU Photo Bank via Getty Images)

Nonetheless, few should argue that frequently changing doctors is a good thing. Doctors are not underwear or air fresheners. Yet these days many doctors are being treated like commodities or some may say poop. Changes in insurance plans and coverage and practice structures may force patients to switch doctors frequently and interrupt continuity of care. Short appointment times and increasing patient loads keep doctors and patients from really getting to know each other. I’ve seen some hospital and clinic administrators treat doctors as if they are “easily replaceable.”

Imagine what would happen if you ran your other personal and professional relationships in this manner? What if you always relied on an Urgent Spouse Center that provided a different person each time you wanted to attend a function, do something with your kids, or make a major decision? What if you never really had a chance to get to know your spouse, as in, “Honey, before we buy this house together, could you remind me your name and history again?” What if you had a serious legal matter and your lawyer told you that you had only fifteen minutes to tell him or her everything about the case? What if an NFL team couldn’t hire certain coaches or run certain plays because they weren’t covered by insurance?

All of this overlooks the power of the patient-doctor relationship in preventing and treating disease, in providing comfort and reassurance when its needed, in helping you navigate the swamp of the healthcare system, and in serving as your advocate. Don’t underestimate the switching costs involved in changing doctors. Each switch means a new doctor has to spend time, effort, and money to get to know you and your history. Each switch means that key information could be dropped or misinterpreted. Plus, when you are sick and other parts of your life are unstable, you yearn for stability in something, especially in who is taking care of you.

This is not to say that the patient-doctor relationship or the health care system shouldn’t evolve. Since much of my work focuses on digital health and computational approaches to enhance decision making, I am all for technology replacing things in health care that do not require humans (e.g., filling out forms, reading X-rays, performing certain procedures, or handling large amounts of information) and facilitating what doctors do. However, replacing long term relationships between doctors and patients is not the way to go. Talking to an app is just not the same as interacting with a real, qualified, and knowledgeable person, especially when you need emotional support.

Moreover, finding a good doctor can be as difficult as finding a good lawyer, a good coach, or a good CEO. So once you find a good one, you’d like to stick with him or her. Doctors are not all the same and not readily interchangeable. But many parts of the health system may be treating them as such. Remember you can always change your underwear after an inadvertent dump but if you dump on good doctors, finding a replacement may not be so easy.

 Source: https://www.forbes.com/sites/brucelee/2018/07/03/what-happens-when-you-see-the-same-doctor-link-with-lower-death-rates/#62cd4934dfb4

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