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Having a Family Doctor Equals Better Care

They can coordinate care, keeping you healthier, study finds

TUESDAY, March 29, 2005 (HealthDayNews) -- People who rely on their primary-care doctor to coordinate their health-care needs fare better than those who don't, a new study finds.

And family physicians who coordinate their patients' care are less likely to get sued for malpractice than doctors commonly believe, a second study contends.

Both papers appear in the March/April issue of the Annals of Family Medicine.

"There is evidence that people who see the same doctor over time get better care," said Dr. John W. Saultz, lead author of the first report and a professor and chairman of the Department of Family Medicine at Oregon Health & Science University.

In their study, Saultz and colleague Dr. Jennifer Lochner looked at data from 40 published studies. Using these studies, they analyzed 81 different patient outcomes for a variety of medical problems.

Among these patient outcomes, 51 were significantly improved when patients maintained a long-term relationship with their primary-care doctor. Only two were worse -- tonsillectomy and advice about hormone replacement therapy. The rest were about the same when patients switched doctors often, the review found.

In addition, having a long-term relationship with a doctor resulted in fewer hospitalizations and other reductions in health-care costs, the researchers found.

Saultz believes that people who have long-term relationships with their doctor benefit by having someone who knows their medical history and can help coordinate their care. "Care that becomes fragmented becomes more dangerous," he said.

"People who like health care when they receive it from a doctor they get to know over time and trust are not sacrificing quality for that," he added. "They are probably getting additional quality."

In the second study, researchers looked at whether family doctors who undertook coordinating the care of their patients were leaving themselves open to lawsuits. They were not, the study found.

"There is a need for physicians to be more proactive in managing treatment for people with multiple chronic illnesses," said lead author and lawyer Mark A. Hall, an instructor at Wake Forest University School of Law. "Having someone who is making sure all the pieces are fitting together is important -- and is not being done enough."

One reason it's not being done more often is that primary-care doctors are worried about liability, Hall said. "They are concerned about being sued for a mistake another doctor might make, or being responsible for too many areas of specialization they are not trained in."

In their study, Hall and his team looked at lawsuits brought by patients receiving coordinated care from a primary-care doctor, and interviewed doctors about their experience. They found "there is really no increased risk of being sued for physicians who perform these functions," Hall said. "The fear that's out there is essentially unfounded."

Two other concerns about having one doctor coordinate patients' care are the lack of complete medical records and the lack of reimbursement by insurance companies for these services, Hall said. "It's a time-consuming role that isn't paid for."

Saultz agreed that how doctors are paid for their role as a health-care manager is an issue. "It is a big economic problem," he said. "It's a service that is worth more to the health-care system than what it's paid for."

In addition, Saultz also doesn't see much additional risk of being sued for coordinating a patient's care. "Statistically, the higher liability risks in medicine go with doing procedures on patients. And coordinating people's care is certainly not as risky as operating on them, in terms of lawsuits."

As far as being sued is concerned, withholding care is riskier, Saultz said, as can happen in situations where "you're telling patients that you don't think care they want to have is necessary," he said. "There are people who think care is very necessary when the insurance company pays, and there's a completely different mind[set] when they are paying for it themselves."

Another expert agrees that a strong relationship with your primary-care physician means better care -- and for the doctor, less risk of being sued.

"We know from prior literature that meaningful relationships between provider and patient also greatly mitigate the risks of litigation," said Dr. David L. Katz, an associate clinical professor of public health and director of the Prevention Research Center at Yale University School of Medicine. "Suing a trusted, long-valued health-care provider is quite a different matter from suing some nameless technician."

Taken together, these two studies make an important case that cuts to the core of modern medicine, Katz said.

"Even in this age of medical 'miracle and wonder,' much still depends on the human connection that is the historical foundation of medical practice," he said. "With that foundation, we can, and should, confidently build new approaches to care that enhance outcomes, without undue worry about what the lawyers will think."

More information

The National Library of Medicine can help you choose a doctor.

SOURCES: John W. Saultz, M.D., professor and chairman, Department of Family Medicine, Oregon Health & Science University, Portland; Mark A. Hall, J.D., instructor, Wake Forest University School of Law, Winston-Salem, N.C.; David L. Katz, M.D., M.P.H., associate clinical professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; March/April 2005, Annals of Family Medicine
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