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I read with interest the views of James Willis1 on the need for continuity of care: it is certainly an area where there should be increasing debate in what is otherwise an age of increasing fragmentation of medical care. I think it is important to remember that when a diagnosis is made and a care plan agreed on, it is exactly that, a plan that is agreed mutually between patient and doctor. Therefore, ones prior knowledge and ability to relate to the patient in questions are extremely important.
However, I would also argue in an age of protocol-driven health care that there are perhaps more important things going on in a consultation for which we don't readily have the scientific measurement. Our instincts as physicians and ability to tune into unconscious communication means that sometimes we quite appropriately run over zealous ‘diagnostic algorithms’ past seeming trivia, and equally seek to reassure those whose symptoms on the face of it sound alarming!
It is experience and personal knowledge of the patient and family that allow one to deal intuitively with some of these apparently unscientific incongruities that face us all the time in general practice. Furthermore and not insignificantly, by and large, most physicians enjoy continuity of care but, I think equally so, find it difficult to pick up threads in complex cases where patients have seen many different doctors sequentially.
General practice is a vocation where continuity of care enhances the patient's experiences and outcome rather than its ‘bureaucratocentric’ health care (apologies for neologism).