Medical care is safer, and cheaper, when there is continuity in who provides it!  My January column in the SC Baptist Courier.


Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to see a physician, physician assistant or nurse practitioner.

This is can be useful when one has no family physician, or can’t get an appointment. It can be difficult and downright dangerous when a person with a persistent medical issue goes from place to place seeking a better answer, better treatment, or in hopes of getting a medicine or test she or he thinks is necessary.

Let’s say that a child has a fever. His pediatrician examines the child and says he has a viral head cold. The fever, as predicted, continues. In two days, on the advice of family, frustrated parents go to an urgent care. There, the diagnosis is ear infection, and an antibiotic is started. On day six, the diarrhea starts (antibiotics often do this) and the fever continues as it so often does with viral illnesses. Then they take the child to the emergency department of the local hospital, where tests may be done, which might (or might not) show something else to treat.

By day eight the symptoms are all gone. The temptation is then to believe that the first doctor was wrong, and the second and third did something useful. That may or may not be true. But what is true is that unnecessary money may have been spent, potentially unnecessary drugs given and possibly, unnecessary X-rays obtained.

The same sort of thing can happen with even worse consequences when a person has a procedure and complication. For instance, a gallbladder surgery is done in one hospital, but when a fever develops two days later the patient goes to a local pharmacy clinic. From there, they’re sent to the urgent care for some other test. They later end up in the emergency department when symptoms worsen. Perhaps their surgeon was never contacted; by the patient or anyone else. The surgeon might have been very alarmed by the fever and have asked the patient to come immediately to the office where her expertise in these things would have been much more expeditious. (And probably cheaper.)

Because medical problems can be very complex and confusing to patients, it’s easy for important details to be neglected when one sees a new physician or goes to a different clinic; in that case disastrous results can occur.

Furthermore, despite electronic medical records, most facilities are not connected. So a visit to a new place is often a visit without one’s old records so the details of other visits are not immediately available.

My point is that continuity matters. An emergency is an emergency and one should seek treatment. But sometimes the convenience of going to a different place for a non-emergency results in confusion for patient and physician, increased cost, unnecessary treatment and unpredictable, sometimes dangerous complications.

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