For 25 years, the trend in medicine has been towards specialisation. In practice, rather than medical care being provided or managed by generalists who knew ‘something’ about many areas, care was provided by specialists who knew a lot about their specific area.
This sounded good in theory but ultimately led to the creation of silos in medicine – fragmentation of the medical care delivered with the patient becoming responsible for coordinating their own care.
The profession has recognised that fragmentation delivers sub-par clinical outcomes for patients and we are now seeing a trend back towards continuity of care.
This can mean:
- Multiple providers in one location to facilitate communication between providers, with the patient no longer having to project manage their own care.
- A team-based approach allowing for the integration of new information and the ability to make decisions from a whole-person perspective efficiently, without extensive investigation or record.
My clinic is taking this approach to maternity care, and it’s shown me how desperately crucial it is when dealing with complex presentations that don’t fit neatly into one box.
Take the example of a patient with an unsettled baby in the postnatal period. Complex feeding issues are contributing to the baby being unsettled, and the baby is starving. But it is also premature. And this too is contributing to the feeding issues. Overlaying this is the anxiety and postnatal depression which may have occurred independently to the unsettled baby, but is definitely worse with the unsettled baby.
Who is best to address this patient’s issue? Is it a neonatal paediatrician? Is it a psychologist? Is it a child health nurse?
The truth is, for this situation and others like it, a team-based approach and carefully coordinated care are needed to meet the patient’s needs effectively.
A clinic that intends to deliver strong continuity of care, needs to be:
- Patient-centred: one where the care is individualised to the patient’s unique needs and the patient is actively involved in the decision-making process
- Comprehensive: all care provided in one location, barriers between providers to be minimal and if the patient is referred to another provider, they do not want to repeat their history, they want the provider to have full knowledge of their condition.
- Relationship-based: True continuity of care, in which the patient and the provider develop a trusted relationship, leads to significantly improved outcomes, both clinical and patient experience.
Moving beyond a system where patient presentations have to be fitted to the individual sub-specialties is a positive trend in medicine and one that patients want. I hope it gains increasing acceptance in the profession. Like in sport, a champion team performs better than a team of champions.
Key messages
- Medical specialisation has had pluses and minuses
- Fragmented care delivers below par outcomes
- Continuity of care invokes the skills of many in a team-based approach.
References available on request.
Questions? Contact the editor.
Author competing interests: nil
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