In the current global health policy dialogue, there is a common understanding that primary care is the corner stone in health care and hence a prerequisite to reach universal health coverage. How can we explain that primary care plays such an important role?
High quality primary care means strong multiprofessional teams including the trained family doctor. Family medicine is a specialty in its own right – with its own curriculum and research base, and it is basically different from other clinical specialties through its core values.
‘’…strong multiprofessional teams including trained family doctor…’’
Our Canadian family medicine forefather Ian McWhinney said: “Family medicine is the only discipline to define itself in terms of relationships, especially the patient- doctor relationship.” What are the implications regarding health outcomes?
The late Barbara Starfield, professor and researcher of public health at Johns Hopkins University, showed that a good long-term personal relationship with a freely chosen primary care doctor not only increases the individuals` health but also the population`s as a whole. Other researchers have confirmed these findings. A research paper published in the British Medical Journal in April 2018 compared a number of high-quality scientific articles on what we call ‘continuity of care.’ Close to 82% confirmed that the quality of ongoing doctor-patient relationships affects mortality rates. The better the individuals` relationship with their long-term doctor, the lower their mortality rate from all causes of death. How can this be understood?
”The better the individuals` relationship with their long-term doctor,
the lower their mortality rate from all causes of death.’’
I am convinced that trust is key. A patient is more likely to follow someone`s advice if he trust them – he is also more likely to share information that he wouldn`t volunteer to a stranger. This information helps the doctor to tailor measures to the individual.
Comprehensive, medical care is more than adding up “the sum of fragments of organ specific medical knowledge”. Biographical data in a broad sense is significant in diagnosing and treating in the family medicine setting – basically nothing the patient presents us with is irrelevant. Maybe this is why conditions like Chronic fatigue, Medically Unexplained Physical symptoms, Fibromyalgia and Irritable Colon belong in family medicine. On a practical level our task is comprehensive when we act as coordinators and guides for our patients into, and within the health care system.
”… comprehensive medical care is more than adding uo the sum of fragments…”
So, we know that the core values of family medicine, expressed in the personal relationship between patient and doctor over time, have impact on health outcomes. Still, we are driving health care towards fragmented specializations. The internationally acclaimed scientist and professor of medicine Arthuro Casadevall believes fragmentation is harmful. He believes that by making doctors more specialized, everyone is digging deeper into their own specialism and rarely standing up to look over into the next trench. The solution to their problem might be right next door, but they’re at risk of missing it because they are so focused on their own field.
”The core values of family medicine, expressed in the personal relationship between patient and doctor over time, have impact on health outcomes…”
Hyperspecializing within medicine has produced a series of really important breakthroughs and innovations – recently a promising treatment for Ebola, and for multi-resistant tuberculosis. But we are also face some serious downsides. The fragmentation of healthcare makes it hard to navigate the system as a whole, and digitalization puts up barriers to personal interaction.The untamed forces of the market play on our fears of mortality and on our quest for a long and healthy life. When we are offered a brand-new product, which promises to sooth our fears and put us back in control of our health, most of us are more than willing to pay.‘
”The fragmentation of healthcare makes it hard to navigate the system as a whole…”
Consumerism affects all fields of society – and is also playing out in health care. These trends challenge the core values of family medicine.
The convincing scientific evidence of the effect of personal, comprehensive and continuous care, should guide us in how we seek medical care in the future. As doctors and patients we should put energy back into building relationships. We need to aim for long-term understanding between patients, family doctors and local nurses. Values based family medicine is the hallmark of family medicine and means better health outcomes for the population.
Anna Stavdal Family Medicine Specialist University Teacher at Oslo University President-Elect WONCA World Organization of Family Medicine