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Invited Commentary
July 2015

Understanding the Value of Continuity in the 21st Century

Author Affiliations
  • 1Division of Hospital Medicine, University of California–San Francisco, San Francisco
  • 2Institute of Health Policy, Management, and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 3Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
JAMA Intern Med. 2015;175(7):1154-1156. doi:10.1001/jamainternmed.2015.1345

For most of the 20th century, patients commonly received care from a small number of physicians over a long period of time. Both generalists and specialists followed a large panel of patients in both the ambulatory and hospital setting for many years. In the United States, physicians' first real experience with continuity came during postgraduate education with longitudinal experiences called “continuity clinic.” Residents followed their “clinic patients” until they left the residency, passing their cohort onto the residents who followed them. Continuity was a core attribute of medical care, prioritized by both patients and physicians as a display of commitment. Since the turn of the century, a growing number of forces have disrupted this continuity, both over the long periods of time as outpatients, and even for a single episode of care during 1 hospitalization. In 2015, patients have a much harder time answering the question, “Who is your doctor?” As physicians (and sometimes patients) who have practiced in both inpatient and outpatient settings, we ponder the natural corollary of this practical question: Is the “old continuity” of the 20th century dying off?

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