Your Face Looks Familiar

As we’ve all made it through the first few sweltering weeks of the new academic year, the inherent value of continuity has proven itself once again to be a critical part of taking care of patients in the outpatient setting.

It’s not that I have a specific example to relate, where a provider knew somebody, and remembered some specific detail from long ago that wasn’t documented in the chart that saved the day. It’s just that seeing patients with the new interns, and giving those patients the opportunity to meet their new primary care provider, has re-instilled in me the power of these unique relationships.

At the end of each academic year, graduating seniors compile a list of their most complicated patients, including those who have pressing urgent clinical needs or active evaluations in progress that need close follow-up, and they go over these cases with the incoming new doctors getting ready to start out their residencies. Each senior’s panel gets handed off one-to-one to a new intern, and we have built rules into our scheduling systems to try and enforce continuity wherever possible. We make an effort to get these critical and complex patients in, to give them the opportunity to meet and bond with their new doctor, and it’s an amazing and powerful thing when you see it happening.

It’s not that a lot of things get solved during this first visit, or that this new fresh look at a patient dramatically changes everything in their management, but knowing that we’ve started out this new relationship on the right foot really seems to matter. Knowing your patients, and patients knowing their doctors, is an incredibly valuable part of the clinical relationship. Try as we might, interim care is never really as good as continuity of care.

For the patient we don’t have a longitudinal relationship with, people tend to stay focused on the problem at hand, getting things solved to get us to another day, and rarely have the bandwidth to see the larger picture, the all-important forest for the trees. I see this almost as problematic as some urgent care visits, where patients tend to get over-tested, over-diagnosed, over-treated, over-medicated.

It’s true, even at all of my own primary care visits with my patients, we can usually only get through one or two or three — or, if we’re lucky, four — medical and social issues, and admittedly it’s probably rare that we — the patients and the providers — always finish feeling that all of our needs were dealt with and satisfied. But knowing that these patients are meeting this new doctor for the first time, and that they’re going to see them again, and that a relationship can build over their 3 years together, has seemed to help get things off on the right foot. At least that’s what these patients, as well as the interns who are becoming their doctors, have been telling me.

A bond is formed. Creating this level of continuity matters at every level of the patient’s care, from those who answer the phone to those who greet the patient on their arrival, those who escort them through the various phases of their visit with us, all the providers who interact with them, take their blood pressure, draw their blood, perform their EKGs, administer their vaccines, those who listen to their lungs and hear their complaints and learn about their families.

Just the other day, while a long-term patient of our practice was being readied for their office visit, having their blood pressure, pulse, and other vital signs taken, they looked up and saw another member of the team walk by, and greeted them like an old friend. “There she is, there’s that young lady. How’s your family? You look younger every day!” Both of their faces brightened, and you could feel the trust, the crucial intimacy of the healthcare setting, grow stronger.

It matters when a patient calls our practice and they recognize the voice, they know they can talk to a particular person who will help them, that people know their names, their faces, their families, some of their hopes and dreams and worries. The more we can build these bonds and bring these patients into our lives to take care of them with confidence, the more likely we are going to be able to get them to the healthiest place we can.

So, let’s build the continuity, forge the bonds, bring back the personal to the healthcare system that lately seems to be missing, as we have tended to industrialize, streamline, and outsource the care we are providing.

These connections can make all the difference. Trust me.

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.