Seeing the same doctor (GP and specialists) over a number of years may be a matter of life and death, according to a study published today. A team of researchers looked at 22 studies from nine countries and found 18 that showed a marked link between continuity of care and lower death rates, after correcting for a range of variables.
If you want a medical opinion nowadays, your options are mind-boggling. But as the range of options increases, your chances of getting to see the same doctor twice are diminishing. It’s like your favourite restaurant forever changing and expanding the menu, but never offering your favourite dish more than once.
You can use AI platforms such as Babylon, which announced this week that its chatbot outperforms doctors in questions from the GP membership exam. Or chat to an algorithm-driven human on the NHS free helpline, 111. Or register with an online GP service that will only see you face-to face in exceptional circumstances. NHS choices offers online, evidence-based, reliable and sensible advice on a huge variety of medical conditions and questions. If you want to see a human being, there are urgent care centres, out-of-hours hub appointments at local surgeries that you can book online or via your own GP surgery or, if you’re very ill or have a lot of time on your hands, you can rock up at A&E. But what if you just want to see a family doctor whom you recognise? Ideally someone you’ve seen with a few bits and bobs over the years and have come to trust? Ah, now that’s going to be more tricky.
So should jobbing GPs such as me, who’ve sat behind the same desk for nigh-on 30 years, who know up to four generations of the same families and are embedded in the local community, accept the seemingly inevitable? Take the nameplate off the front door and get well-paid locum work for a private provider that populates large health centres with GPs who are paid by the hour?
What does the public really want? When you’re busy, working and essentially well, you probably want an efficient way of getting prescriptions and a quick way of checking whether what you’ve read on Google is correct. GP surgeries are variable but most (79%) are rated “good” by CQC, which means they have had to demonstrate that they’re safe, effective, caring, responsive and well-led. That should include electronic prescribing to send routine prescriptions to your nominated pharmacy, an online appointment-booking system and good access to healthcare professionals via the phone and email.
When you’re ill, distressed, confused or scared, it’s normal to want to see someone you know and trust. A study published last year showed that older people who see the same GP over time have fewer avoidable hospital admissions. This was particularly true for people who see their GP a lot. There tended to be less continuity of care in larger practices. In a linked editorial, researchers said that seeing the same doctor “builds trust and a sense of mutual responsibility”, while a primary care system that is increasingly fragmented means that patients may choose A&E instead.
For me, the key words there are “mutual trust”. If I were to work as a locum, sent to a different practice each time, I would act professionally and do the job. But would I try as hard, stay as late and fret as much as I do for the patients whom I’ve known for 30 years? Would I be as effective if I didn’t have any local knowledge of services, pathways, specialists and hospitals? Babylon would certainly beat me in some MRCGP exam questions but does an AI tool tease out the human story, the unspoken fears, the existential torment? I’m not saying that in a rushed 10-minute consultation I get it right all the time. But medicine is an art as well as a science, and meaningful communication lies at its core.
For a proper heart-to-heart, most of us want to speak to another human, preferably one we know.