Time to rethink continuity.

Continuity of care is a value that lies at the very heart of family medicine. It is one of those powerful, traditional values of general practice that we have accepted as being at the centre of our discipline. It refers to a continuous relationship between one physician and one patient over an extended period. It sometimes involves contact through many illnesses and life challenges. Research has reported on the greater satisfactions that come from a longitudinal relationship for both patient and physician; on the education and illness prevention that can occur with such long relationships; and on lower numbers of diagnostic tests and hospital admissions, and shorter hospital stays. All these are benefits of a longterm relationship between patient and physician. Such benefits also include a better capacity for advocacy on behalf of patients and, in the long run, better care. The downside of longitudinal relationships can be complacency on the part of physicians and sometimes patients’ perceptions that physicians care little about the relationship. Today we live in a somewhat fragmented world (some would say greatly fragmented). Relationships generally are short-term and less continuous than they were a few years ago. Young people move away from families to find work. Ideas regarding the community are changing, with less emphasis on long-standing relationships and more emphasis on economic and job opportunities. It is possible to be on the move and remain in a continuous relationship by means of television, with Ally McBeal or favourite hockey team, but not with a physician. Young physicians seem to want part-time work, to move frequently, and to be less likely to make long-term commitments to a particular practice. (The College of Family Physicians of Canada has been criticized for not training young physicians to take on long-term relationships, but this is an international phenomenon and not simply confined to Canadian medicine.) At the same time, the physician-patient relationship remains at the centre of our discipline, and patients are clear that they want doctors who listen Time to rethink continuity