The vanished health care system? Diminished maybe but not dead yet!

In a NYT Health Blog Dr. Dena Rifkin describes how far we've come from "the vanished health care system in which doctors were available for their own patients 24 hours a day..."

The blog then describes how the health system can work around the lack of continuity & broken relationships that are so fundamental to good primary care.  This is a troubling evolution due the strong links between relationships-over-time (aka continuity) and important outcomes.  Turns out that when we break up continuity our patients suffer - fewer patients follow through on needed preventive and chronic disease care and more end up in the hospital.

Why do we have to accept workarounds and the kinds of risks described in the post when it is not only possible but delightful to practice in the 'vanished' system of 24 hour care for one's own patients?
Until my family moved out to Seattle for my wife's new job and I had to close my practice, I took 24 hour call for my patients. It was delightful to know the people and back story when I received a call from someone with a need. 

I was very pleasantly surprised to find that the number of calls I got after hours dropped dramatically and I was awakened from sleep only about twice a year.

This old school approach may have vanished from much of the US but it's not gone yet. Doctors are rediscovering the incredible benefit to themselves and their patients when they reduce the barriers and open themselves up to their patients. 

Systems that support continuity are putting a stake in the ground for quality and meaningful outcomes.  Dr. Rifkin urges us to remember the unquantifiable value of asking the right questions, but we can also remember to measure and hold ourselves accountable to good continuity and access: do our patients say that they can get care when and how they need it?  Do our patients know to whom to turn when they have a medical question or issue?  If not, our system is not supporting good care.  These issues are quantifiable and we know what questions to ask.  Now we just have to be brave enough to ask them and act accordingly.

Note to colleagues: 24/7 access is possible and even enjoyable only in supportive systems - so if you're in a hamster wheel practice you want to think twice about trying this out.  For the way-too-many of you in  non supportive systems, start thinking about your exit strategy.