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December 3, 2018

Long-term Physician-Patient Relationships—Persevering in a Practice

Author Affiliations
  • 1Department of Medicine, The University of Chicago, Chicago, Illinois
JAMA Intern Med. 2019;179(2):141-142. doi:10.1001/jamainternmed.2018.6735

Few physicians or patients question that a stable, long-term physician-patient relationship is a good thing. Despite this, these relationships are increasingly rare. The demands of electronic documentation, the stress created by the myriad ways that patients can access their physicians today, and the declining reimbursement for primary care all make maintaining a long-term practice challenging. At the same time, our increasingly mobile society and the restrictions on physician choice imposed by payers make remaining with the same physician difficult for a patient.

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    5 Comments for this article
    Healthy Patient Avoidance of Physician Visits
    Helen Hunt, MA | N/A
    Some people who are advancing in age are healthy and strong, without risk factors other than age. In medical jargon, they may meet criteria of "ideal cardiovascular health". Rather than schedule physician appointments, they may place great value on adhering to healthy food consumption, frequent exercise, healthy weight and waist size, maintaining healthy blood pressure - which they monitor themselves and can improve by increasing vigorous exercise or dietary approaches, etc. False positive test results or inappropriate medical interpretations or diagnoses can be a nuisance which healthy people may wish to avoid. So a question arises: Can a strong healthy person who is advancing in age best avoid inappropriate medical "findings" or pharmaceutical prescriptions by not showing up at a physician's office?
    Continuity of care.
    Michael Plunkett, M. D., M. B. A. | Solo practice
    Well thought out and well written.

    Having been in practice for 42 years now I fully agree with Dr. Cifu’s thoughts. I have some four generation families in my practice and it’s very rewarding. And, as stated, as the practice matures it’s a little painful to lose these wonderful people. But I think it’s a comfort to them and their families to have “their doctor” there for them at the end.

    As the article states the future is less certain.
    I fear my children and grandchildren will have no
    one to care for them. And I mean CARE.

    When I was at the University of Chicago, Dr. Marc Siegler gave a talk on “curing versus caring.“ I think today’s talk would be “documenting versus compliance.“ i’m not so sure caring is very high on any medical school professor’s agenda today.
    Michael Plunkett, MD MBA | Practice amd teaching
    Well stated. I’ve been doing it for 42 years and it’s very rewarding. And it’s been easy. The only hard part is, as mentioned, losing so many nice people as they “age out.“

    But I feel like the blacksmiths did. In the coming new world order it’s all going to be transactional. Not good for the physician. Disastrous for the patient. One size will fit all.
    It will all be in the algorithm. They’ll get their vitamin D and their statin and a boilerplate visit summary and their “provider” won’t
    even remember their name.

    Plus ca change.
    Long term relationships
    David Johnson, BS Biology. MD. | Private practice 37 years. OSF Medical Group Peoria Il
    I was in an internal medicine private practice group of four to five physicians for 37 years. I agree wholeheartedly with the concept of long term physician-patient relationships. I thoroughly enjoyed my career. We were affiliated with the local medical school. We had our own hospital service with interns, residents, and medical students assigned to our group at one of the three hospitals where we had patients. Residents and medical students rotated through our office. When retirement came along, my wife said " Now maybe you'll have more time to spend with your friends." Then she said "But your patients are your friends." Truer words were never spoken. We became employees of one of the hospitals in 2011. We couldn't recruit any new physicians to do what we did. We worked about 65-70 hours a week for all those years. We had very supportive wives, and all have been married for fifty years and more. I continued to work another 4 years prn after I sort of retired in 2013. Wouldn't trade my life as a physician for anything. It meant so much!
    Does taking care of long-term patients get easier?
    Edward Volpintesta, BA,MD | bethel medical group
    February 5, 2019

    Re: Cifu AS. Long-term Physician-Patient Relationship—Persevering in a Practice. Jama Intern Med. 2019; 179(2):141-142.dpo:10.1001/jamainternmed.2018.6735
    I don’t think that long-term relationships with patients make it easier for primary care doctors to take care of their patients. In fact I think it makes it harder.
    Why? I have been in a stable practice for over 40 years. During that time as my patients got older many of them developed chronic diseases and I have to spend more time with them than when I first started seeing them.
    Its like this. I am in touch with
    2 or 3 consultants routinely discussing their care. I receive many fax reports on tests that they ordered including MRIs, CAT scans and many blood tests and recommendations that I have to review.
    I spend greater amounts of time discussing their problems and prognoses with them as time goes by.
    And as they aged their illnesses became more complicated and required more frequent visits.
    So it hasn’t been easier for me providing medical care to my long-term patients at all.
    What has made my medical practice easier, and what sustains me, however, is when my patients tell me that they appreciate my care and the mutual friendship that have grown through the years.
    Edward Volpintesta MD (general practitioner)