The answer to everything wrong in health care

TOP Alberta has released a beautiful infographic Evidence Summary: The Benefits of Continuity in Primary Care, and the document also serves as an overview of the 112 publications they reviewed.

It speaks for itself. Maybe the title of this post is a bit grandiose, but as a shameful hypocrite [I have very little continuity in my clinical practice, something I'm working to remedy] I cannot underscore how important this idea is.

Every physician, nurse, administrator (yes, you!), health policy person, and their uncle needs to not only know this but act on it. Continuity is what we need.

It's not a fad. It's something that we used to have. And it has slowly been eroded, without too many people noticing, as we kept focussing on the newest technology and the latest pharmaceuticals as if they would solve everything.

In BC, the essential nature of continuity has been recognized particularly with the work of Marcus Hollander and was implemented in the GP for Me/Attachment Initiative. Unfortunately (some might dispute this), changing physician incentives to try to encourage more attachment hasn't made much of a difference for patients. So while we know that we need continuity, we don't know how to 'make' the system or the providers do it.

It's a perfect storm for patients: Can't find a GP, or if you can it's hard to build a relationship with them because they are so busy/unavailable/don't have enough time to spend with you; the GP doesn't know all the details of your care as pharmacists/naturopaths and others expand their scope and don't communicate with the GP; the medical records at the hospital or from the specialist in the other city don't link with those of the GP so no one knows what is going on; when a referral or requisition is sent, there is no confirmation that is was received so it might be that you are just waiting, or it might be that it has been lost and you will never hear back about the appointment; when a home care support worker or nurse comes, it is a different person each day and they don't know you or your needs, and they aren't allowed to do the things you need help with most.

Health care really is about caring for people, and how can we do this when we do not build robust and lasting relationships?

The review did not cover provider satisfaction but personally and in BC studies so far, physician satisfaction is improved by continuity with patients. However, this is not how most young graduates are practicing; Yet another great reason that we need to look more into this.

Is it too good to be true? Before we rush ahead and try to force the "magic pill" of continuity, we need to know more about why it's being eroded, and if we can save it, then how?



You'll hardly believe these 6 nerdy ideas! aka Buzzfeed's 'Misconceptions about Screening'

Yes, it's true, even the popular 'internet news media company' Buzzfeed is hosting an article highlighting the issues that arise with the current practice of disease screening. Known for horribly-titled and irrelevant news-utainment, with headlines like "The 21 Erotic Moments From The First Time You’re In A Bulk Barn," the site does have over 200 million viewers monthly. They must be doing something right, and hopefully this Buzzfeed Community post, Misconceptions about Screening, will be a viral hit, just like "These American Tourists Were Delightfully Puzzled By Awesome Canadian Road Signs."

In the post, Sense about Science, a UK-based organization that 'equips people to make sense of scientific and medical claims in public discussion,' wrote:

There’s a huge amount of discussion about screening programmes from celebrities, campaigners and emotive media case studies. Unfortunately, a lot of this discussion is filled with misconceptions, misinformation and unrealistic expectations of what screening programmes are and what they can deliver. This has real lasting implications for patients and healthcare professionals. This needs to stop.

They go on to review 6 key issues with broad-based screening campaigns, highlighting the grey areas in screening test results, the costs and harms of these tests, the different role they play as compared with diagnostic tests for symptomatic individuals, and the idea that screening must be employed only for the right population and the right diseases.

One of the Making Sense of Science infographics on the topic of screening.

One of the Making Sense of Science infographics on the topic of screening.


Much of the culture of screening has been created by the medical industry and by health care practitioners, but the celebrity 'experts' have not helped. This article reminds Buzzfeed readers, many of whom follow celebrity news, to think twice about listening to this unscreened advice.

Read Making Sense of Science's 'MAKING SENSE OF SCREENING: A guide to weighing up the benefits and harms.' Other similar tools can be found in the health care provider section, the patient section, and the 'hands-on' section (mostly tools for shared decision-making) on this site.



Simple tool illustrates risks/benefits of prostate cancer screening

Struggling with what to do as far as prostate cancer screening?

The Harding Center for Risk Literacy has some very helpful illustrative "Fact Boxes" that share the evidence behind Digital Rectal Exams (DREs) and Prostate Specific Antigen (PSA) tests.

See the "Risks and benefits of prostate cancer screening" on their site.

Of course, these shared decision-making (SDM) aids only take into account the Cochrane Review, but this is a systematic meta-analysis and so I think quite powerful data.

To see a bit more background, but a similar conclusion, view this review in the Journal of Family Practice. They suggest:

Do not routinely screen all men over the age of 50 for prostate cancer with the prostate-specific antigen (PSA) test. Consider screening men younger than 75 with no cardiovascular or cancer risk factors—the only patient population for whom PSA testing appears to provide even a small benefit.

Family medicine literature seems to be consistent with the above, though our practice lags behind. Many of my urologist colleagues shake their head and insist that we offer screening PSAs, but I'm beginning to feel it just doesn't add up to "good care."

What do you think? Would you get screened? Would you encourage your patients to be screened?

If you are looking for more decision-making aids, check out the Hands On part of the Tools section on this site.