CommentHealthOpinion

Live longer with care from the same doctor

Research published last year by the British Medical Journal (BMJ Open) reveals that the continuity between patient and doctor is associated with lower mortality rates. The study observed that patients across ages, cultural boundaries and all conditions appear to benefit from continuity of care with both generalist and specialist doctors. In other words: patients will live longer being cared for by the same doctor or the same group of doctors.

 

The study is significant because it calls for continuity of care to be given a higher priority in healthcare planning. “Continuity of care with doctors – a matter of life and death? A systematic review of continuity of care and mortality” concluded that, despite numerous technical advances, continuity of care is an important feature of medical practice with interpersonal factors remaining important in patient care.

The article also mentioned that research on the human aspects of providing medical care has lagged because internationally there has been a decrease in the perceived value of personal contact between patients and doctors. In fact, an editorial in the New England Journal of Medicine suggested that non-personal care should become the “default option” in medicine, with artificial intelligence (AI) potentially replacing the need for doctors.

In June 2018, researchers demonstrated that AI can identify skin cancer more accurately than dermatologists when put head to head in a small study. The deep learning convolutional neural network (CNN AI) was able to beat a group of 58 dermatologists in distinguishing melanoma from benign moles. However, don’t be too soon to give up going to your dermatologists, as this AI is just only been trialled and no system is yet available widely. As society places increasing emphasis on technology (and costs), such as CNN for medical purposes, I hope that we will remain conscious of the other important needs of patients.

As a GP, patients tell me they value their interaction with their doctors and it’s the kindness, respect, expertise and care they receive from their specialists and other health providers they mention consistently. No one talks passionately about the machines or technology and so it is difficult to understand why there are researchers in health and medicine talking down the personal contact between patients and doctors.

I also supervise and teach medical students and junior doctors, and I try to share my 30 years of clinical experience, especially around the importance of patient-centred care. I believe this could be better taught in medical schools and during hospital rotations.

People are complex and it is important to consider the whole person in collaboration with their carers or family to make the right decisions for the individual patient. This is the patient-centred model of care and I’m sure the reason continuity of care by doctors is associated with low death rates is because the doctor understands the needs of their patient and can provide the best advice and management for their patients.

Unfortunately the “art of medicine” and “soft” concepts cannot be easily researched, as this data is considered difficult to quantify which impacts on health funding considerations. Perhaps that is why specialist or hospital medicine can be easily researched, thereby funded increasingly by governments, whereas general practice, which deals with chronic multiple conditions of disease, is more difficult to quantify.

If healthcare planning and funding is driven solely by research alone it is unlikely to value these “soft” parameters that are essential to capturing the value of personal contact between patients and their doctors. With this in mind, one thing that I am sure of as a GP is that I will never be replaced by artificial intelligence. AI can only do one thing exceptionally well – it cannot multitask over a variety of concepts and parameters. So I think it will be a long time before scientists can come up with something to replace the doctor-patient relationship with artificial intelligence.

 

 

Dr Aline Smith is a GP in private practice and lectures at the UNSW Academic Unit at Fairfield.

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