Consulting with doctors remotely and using telemedicine or virtual health care is clearly here to stay and will only grow in the months and years ahead.
But the lack of personal contact and continuity of care with the same physician could have an unintended, and very unfortunate, consequence. It may shorten your life.
A decade ago, a group of researchers from the University of Iowa carried out the first study to evaluate death rates with continuity of care, or the repeated contact between a patient and one particular doctor in an outpatient setting.
They analyzed data from 5,457 people aged 70 or over and followed up over the next 12 years, as more than half— 54 percent—died.
Using two distinct methods of measurement and taking into account many factors that could influence the results, they found that continuity of care led to "substantial reductions in long-term mortality."
It appears that something as simple as not changing doctors may help add years to your life.
First-Ever Review Finds “Clear Evidence” — A Matter of Life and Death
The University of Iowa study inspired a number of additional reviews by other research groups, and in 2018 the first systematic review was published in the British Medical Journal.Of the 22 studies included, half were from the U.S. and Canada, with most of the rest from four countries across Europe.
The researchers found a "clear preponderance of evidence is in favor of the association," with 18 of the 22 studies demonstrating that greater continuity of care is linked significantly to lower mortality.
The researchers concluded that "continuity of care is an important feature of medical practice, and potentially a matter of life and death."
A further review has just been published in the British Journal of General Practice. Of the 12 studies included, nine showed a reduction in deaths from any cause with greater continuity of care.
In their conclusion the researchers wrote, "Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policy makers and practitioners to counter this."
Why Does Continuity of Care Lengthen Life?
The research doesn’t boil the findings down to one easy answer. However, we can draw a number of conclusions, as the researchers did, about the benefits of a good doctor-patient relationship over time. For instance, when you have developed knowledge, trust, and respect between you and your doctor, you’re more likely to experience:- Decreased hospitalizations and emergency department visits
- Greater incidence of preventative measures such as immunizations
- Better compliance, because you’re more likely to take the doctor’s advice and medications as prescribed
- Better communication, because you’re more likely to be open and disclose more relevant personal information
- Increased satisfaction, providing an ‘optimism’ boost to your health
- Enhanced physician knowledge leading to medical management that’s more likely to be tailored to your needs, resulting in a better quality of care
Pushing Remote Doctor-Patient Contact
In spite of what appears to be clear evidence that this in-person relationship is important, editors at the New England Journal of Medicine are touting the benefits of remote doctor-patient contact.In an editorial written in 2018—long before the coronavirus pandemic—Harvard professor Thomas H. Lee and his colleague, professor Sean Duffy from the United Kingdom, argued that in-person visits should be "the second, third or even last option for meeting routine patient needs."
So long as a high-quality system of routine non-visit care is developed, the researchers went on to say, they believe medical care stressing remote visits would work better for many people.
At one of America’s leading health care providers, over half of more than 100 million patient encounters each year are now 'virtual visits' using a phone, tablet or computer, yet these only scratch the surface of what’s possible with today’s technology, they write.
In the model they believe could be created, people with chronic healthcare needs "stand to benefit dramatically from this type of system redesign," and for those who require the most medical services "an 'in-person as last resort' system should aim to bring as much of the necessary care and social support into the patient’s home as possible."
With patient needs being addressed efficiently, such a system also benefits doctors because it "deepens their partnerships with patients."
Patients will also know that clinical necessity would be the only reason to see a doctor in person. This, they believe, will lead to increased patient loyalty.
A Questionable Fad
My reaction to all the optimistic predictions for remote medical care is “don’t count on it.”Perhaps I’m old-fashioned, but I still believe in the value of an in-person visit with a good integrative doctor. I can’t help but wonder if the real benefit to the doctors, medical centers and hospitals of remote medical care is saving money.
If this is where our medical care is headed, and I think it is, it’s all the more important for you to have a firm grasp on the basic tenets of good health and to arm yourself with information on conditions that already affect your health or could affect your health.
Of course, because of the coronavirus pandemic, these professors’ vision for medical care is already becoming reality without the carefully-thought-out framework they’ve recommended. Only time will tell what kind of impact this will really have on people’s health and longevity.
The evidence for the value of personal encounters with your doctor makes me think of other areas where virtual contact is turning out to have harmful effects. I’m thinking of all those teens and twenty-somethingswho spend all their time on a screen and have soaring rates of depression and loneliness.
I’m also thinking of my own experiences at managing people in an organization. I’ve found it’s far better to have a team together in one place, in person. You can’t do everything by phone, email and text. Often, the casual encounters in the office and impromptu brainstorming that take place in person produce some of the best ideas. And the personal bonding is valuable, too. Not to mention the fact that most people work in a more focused, disciplined way in a workplace than at home.
No, don’t count me as a fan of the big move toward “virtual everything.”
