Health

Benefits of seeing the same doctor

DR DERRICK AARONS

Sunday, July 22, 2018

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WHEN you fall ill, who do you see for your health care? Do you seek the same doctor every time, or do you use a centre, office or health institution where there is a different doctor each time?

If you have chronic conditions — that is illnesses which require long-term treatment, such as diabetes, high blood pressure, high cholesterol, heart disease, arthritis, and other conditions such as collagen vascular diseases — you will be required to visit the doctor regularly for the proper management of your condition. What you choose to do about your medical condition may actually affect how long you live.

The history of patient health care over the past three centuries has evolved from a single doctor providing care to the individual patient and so developing a strong doctor-patient relationship, to the current scene where various doctors may be providing care to the patient within the health care setting. While this may be understandable if the patient has several conditions (co-morbidity) that need to be managed by various specialists, when the patient has only one condition but is being seen by a different doctor each time for the same condition, then the issue becomes a matter of significant concern.

Doing the research

Researchers are scientists who notice possible associations between two or more factors, and wish to ascertain if their suspicions are in fact true. Consequently, they propose what is called a scientific hypothesis, and then proceed to conduct research which seeks to prove the hypothesis, that is, to discover if what they notice is true.

There are internationally accepted methods for conducting such research, some of which you may have heard about such as qualitative research, quantitative observational research, and randomised clinical trials (accepted worldwide as the 'gold standard' for conducting research as, in the main, it eliminates bias and random associations between the different variables being studied).

Over the past 100 years research has made crucial, if not critical additions to our knowledge of the world and the campaign regarding diseases, associated factors, and the means to improve the quality and length of life for human beings in various settings. The consequences of patients being seen by different doctors was recently researched in medical literature, and has revealed that death rates may be lower when patients see the same doctor over a period of time.

Lower death rates

The research, published in the British Medical Journal, involved a systematic review of the relationship between mortality (death rates) and continuity of care. It analysed 22 research studies published over the past 21 years and found that higher levels of 'continuity of care were associated with lower rates of mortality. The continuity of care for patients was received from primary care doctors as well as from specialists in nine countries and across six continents, thus suggesting that the effect was not limited to one branch of medicine or health care system.

It also revealed that while great advances have occurred in the technological side of medicine, the human side of medicine and the consequences for the individual patient have been neglected, with treatment focusing mostly on physical factors within the doctor-patient interaction.

The advantages of an individual doctor's personal care include improved patient satisfaction, increased likelihood of a patient following medical advice, improving the uptake by the patient in adopting personal preventive medicine, and also significantly reducing unnecessary admissions to hospital.

The quality of

The research further found that, from the patient's perspective, continuity of care was associated with their perceiving that the particular doctor was more responsive, and thus encouraged patients to disclose more to the doctor, thereby allowing medical interventions to be more effectively tailored to the individual needs of the patient.

This research provides an important lesson for health care systems that are not patient-oriented or focused specifically on the needs of patients. The issue not only revolves around respecting or not respecting the autonomy of the patient in determining the doctor they wished to see, but also becomes a matter of quality in health care and health care outcomes.

It is well known that some patients communicate better with some doctors more than others, and so the issue of a personal relationship has been undervalued lately or disregarded within some health care systems. Hopefully, the findings of this research will reorder the priorities within the health care system.

Dr Derrick Aarons MD, PhD, is a Jamaican family physician and consultant bioethicist; a specialist in ethical issues in health care, research, and the life sciences; and is the health registrar and head of the health secretariat for the Turks & Caicos Islands.

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