Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
EditorialEditorial

Continuity in the age of virtual care

Nicholas Pimlott
Canadian Family Physician January 2022, 68 (1) 7; DOI: https://doi.org/10.46747/cfp.68017
Nicholas Pimlott
Roles: SCIENTIFIC EDITOR
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading
Figure

Be silent as to the services you have rendered, but speak of favours you have received.

Seneca

Recently, I participated in a debate at my home hospital. The title was “Virtual care is here to stay—but should it be?” The resolution was, “Be it resolved that the majority of clinical care can be delivered most efficiently virtually.” I argued against the resolution.

One of the main arguments I made was the importance of continuity of care. Dr Ian McWhinney captured this concept best: “What does it mean to be a family physician? For me it means that our relationship with our patients is unconditional … ended only by death, by geographical separation, or by mutual consent.”1

There are different ways of thinking about continuity of care—a physician’s willingness to take responsibility for a person’s longitudinal care—and its central importance in the work of family doctors. One way is at the level of relationships and their effect on individuals and communities.

Few have described this better than Dr David Loxterkamp does in his recent essay “The lost pillar: does continuity of care still matter?”2 At the heart of it is a story he first heard when he established his own practice more than 3 decades ago. It is a story we could call “You’ve done a great job, Doc” (read the essay).2

A second way of thinking about the value of continuity of care is at the systems level. In 2018, Pereira Gray et al published the first large systematic review of the literature demonstrating that continuity of care by both specialist and generalist physicians is associated with lower mortality rates across cultures.3 That same year, Bazemore et al showed that higher continuity with a primary care physician results in fewer hospitalizations and lower health care costs.4 In a recent systematic review, Baker et al found an inverse relationship between all-cause mortality and continuity of care.5

However, as evidence mounts for the impact of continuity of care, why is it that, as Dr Loxterkamp argues, family medicine has neglected continuity as a core principle? There have been powerful social forces acting over the past half century that have undermined the kind of personal continuity of care captured in Dr Loxterkamp’s essay—urbanization following the Third Agricultural Revolution of the 1950s and 1960s, atomization of families, the rise of consumer culture, and the growth and increased complexity of medical care itself. Perhaps those who have chosen to practise in rural and remote communities are among the last of us to experience the kind of continuity Dr Loxterkamp describes.

In the first few months of the pandemic, family physicians and their patients enthusiastically embraced virtual care as “good enough” care. But could the expansion of virtual care during this time lead to further disruption in the pillar of continuity? One of the unexpected consequences was “a corporate stampede into primary care” as described by family physicians Drs Sheryl Spithoff and Tara Kiran in an article published a year into the pandemic.6 Among the concerns they raised was that this corporate buyout of primary care practices could lead to the promotion of transactional over relational care, further disrupting continuity and exacerbating the inverse care law.7

In a valuable Teaching Moment article in this month’s issue (page 74), Drs José François and Émilie Fowler tackle the challenge of how to provide experience with continuity of care for residents within the context of the Patient’s Medical Home model.8 The 4 principles they articulate are ensuring that residents understand and value continuity in the model, ensuring that patient needs are at the centre, embracing the interprofessional model for clinical and educational continuity, and optimizing resident scheduling to allow for continuity.

Every generation of family physicians faces challenges to the principles we value and the kind of care we provide. On the cusp of a virtual revolution, it is vital that we commit to teaching the value of continuity of care and preserving it in our practices, difficult though this may be.

Footnotes

  • The opinions expressed in editorials are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

  • Cet article se trouve aussi en français à la page 8.

  • Copyright © 2022 the College of Family Physicians of Canada

References

  1. 1.↵
    1. Robertson PD.
    He was Canada’s father of family medicine. Globe and Mail 2012 Oct 23.
  2. 2.↵
    1. Loxterkamp D.
    The lost pillar: does continuity of care still matter? Ann Fam Med 2021;19(6):553-5.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Pereira Gray DJ,
    2. Sidaway-Lee K,
    3. White E,
    4. Thorne A,
    5. Evans PH.
    Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018;8(6):e021161.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Bazemore A,
    2. Petterson S,
    3. Peterson LE,
    4. Bruno R,
    5. Chung Y,
    6. Phillips RL Jr.
    Higher primary care physician continuity is associated with lower costs and hospitalizations. Ann Fam Med 2018;16(6):492-7.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Baker R,
    2. Freeman GK,
    3. Haggerty JL,
    4. Bankart MJ,
    5. Nockels KH.
    Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract 2020;70(698):e600-11.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Spithoff S,
    2. Kiran T.
    The dark side of Canada’s shift to corporate-driven health care. Globe and Mail 2021 Apr 30.
  7. 7.↵
    1. Hart JT.
    The inverse care law. Lancet 1971;1(7696):405-12.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. François J,
    2. Fowler É.
    Continuity in the academic family medicine teaching environment. Exploring the potential of the CFPC’s Patient’s Medical Home. Can Fam Physician 2022;68:74-6 (Eng), e18-21 (Fr).
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

Canadian Family Physician: 68 (1)
Canadian Family Physician
Vol. 68, Issue 1
1 Jan 2022
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Continuity in the age of virtual care
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Continuity in the age of virtual care
Nicholas Pimlott
Canadian Family Physician Jan 2022, 68 (1) 7; DOI: 10.46747/cfp.68017

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Continuity in the age of virtual care
Nicholas Pimlott
Canadian Family Physician Jan 2022, 68 (1) 7; DOI: 10.46747/cfp.68017
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Continuity in the academic family medicine teaching environment
  • La continuité à l’ère des soins virtuels
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • La douleur chronique en pratique familiale : recherche et réflexions
  • Chronic pain in family practice: research and insights
  • La compression de la morbidité est morte; longue vie à la compression de la morbidité
Show more Éditorial

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire