Continuity of care

Commonly in modern medical practice the patient consults or is reviewed by several different doctors. This is true both of general practice and hospital care.

Commonly in modern medical practice the patient consults or is reviewed by several different doctors. This is true both of general practice and hospital care.

In general practice a patient may attend regularly but see a different doctor each time. The tendency can be for each doctor to regard their consultation as a "first", being the first occasion on which they see the patient. In reality there is often a pattern of illness but this is not clearly apparent, leading to delays in investigation, referral and diagnosis. This trend is seen in many of the complaints and claims we deal with. Outcomes for patients can be severely compromised.

It can be very helpful to have a summary at the end of a consultation with an outline of the differential diagnoses and management plan being considered. This allows the next GP who reviews the patient to have a full understanding of what has transpired. It should be remembered that previous entries, sometimes spanning several weeks or months, will give essential clues, and scanning of the records in this way is an important part of the assessment of the patient.

In hospital care, a particularly risky time where continuity of care is lost or delayed occurs when a consultant colleague is asked by another to become involved whilst on call or to cover a short period of leave. Thereafter, whilst the on-call consultant believes his/her involvement is at an end the other may not be alert to the need for further intervention, for a variety of reasons. It is not clear why these situations occur - and here lies part of the problem, lack of clear documentation. This is essential to assist the various doctors involved. All too often assumptions are made that problems have settled or been resolved and this is later shown not to have been the case.

Appropriate documentation and clear communication between the various doctors is essential in order to provide adequate care for the patient.

ACTION: Clear communication and appropriately detailed records are essential to maintain continuity of care both in general practice and in the hospital setting.

Dr Gail Gilmartin, medical adviser, MDDUS