We congratulate Ridd et al on an interesting approach to cancer diagnosis in general practice, but were disappointed that in 2015 they could write:
‘Seeing the same doctor is associated with higher patient satisfaction but evidence that it makes a difference to patient outcomes is weak.’ 1
Patient satisfaction is itself a major patient outcome, not something separate.
Prospective randomised trials in this field can be unethical, so that much of the available evidence is observational. However, two randomised controlled trials have been done and both were positive for continuity of care.2,3
Numerous international studies reveal that continuity of generalist care is significantly associated with better compliance, better care for people with diabetes, the development of trust in medical generalists by patients, provision of more personal preventive care, significantly fewer hospital admissions for elderly ambulatory care, and lower all-cause mortality. The large number of studies reported are not in equipoise, there are several with no definite result, but about 100 with a positive association, and only three, including Ridd et al,1 with an adverse effect.
On the balance of probabilities, continuity of generalist care is beneficial to patients, and both patients and clinicians deserve to hear that message.
- © British Journal of General Practice 2015
