The Guardian view on the patient-doctor relationship: human connection is part of health | Editorial
In the book that Anatol Broyard wrote about being diagnosed with cancer, he described wishing his doctor would brood about my situation, perhaps for five minutes, that for once he would give me his whole spirit… search my soul as well as my flesh, to understand my illness, for every man is ill in his own way.” Given the desperate state of Britain’s healthcare system, such a call for personal attention could sound like messages coming in from another world. But a new study from the University of Cambridge provides some of the strongest evidence yet that strong doctor-patient relationships contribute positively to health.
The study, which focused on GPs, found that seeing the same GP at every visit meant patients chose to wait an average of 18% longer between appointments. Although this study did not look at outcomes, the frequency of visits was considered indicative on the basis that patients in better health are less likely to seek help. An existing body of evidence has highlighted the benefits of continuity of care in the primary (non-hospital) setting, including: higher patient satisfaction And reduced hospital admissions. This latest study highlights the benefits within primary care, as patients allowing longer intervals between visits can free up millions of appointments.
In seeking productivity gains in healthcare, reformers often emphasize technological innovations and the urgent need to address labor shortages, which are a global problem but particularly acute in Britain. While new medicines and machines are obviously crucial tools, this research is a timely reminder that the social nature of healthcare and care services can never be separated from the people who give and receive them.
On an emotional level, many people take this for granted. Of course, many of us, especially the growing number dealing with long-term conditions, prefer to discuss them with someone we know. Because doctors can understand the test results of known patients more quickly, there are efficiency gains. But the underfunding of primary care compared to acute hospital trusts, as well as the emphasis placed on ease of access (the speed at which it is possible to get appointments), mean that these relationships have not been prioritized in recent decades. Data shows that the percentage of patients who “always or almost always” see their preferred GP has remained the same decreased since 2009.
Instead, and in line with developments in other public services, including educationmanagement systems tend to encourage those performance elements that are easiest to measure. In primary care this means that the emphasis is more on the quantity than on the quality of the appointments. Jonathon Tomlinson, a GP and writer, has written eloquently about his frustration with the disease incessant demand for data entry when his interest and expertise lies in people and their problems.
In a time of severe staff shortages, there are no easy solutions. Prof. Stefan Scholtes, one of the authors of the new study, notes that any change to a system has unintended consequences. But the prospect of productivity benefits from stronger doctor-patient relationships should attract politicians, including Labour’s Wes Streeting, at a time when polls show the NHS as the biggest concern among voters. Broyard’s desire for a greater share of his doctor’s attention need not be seen as an anachronism after all.