0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Understanding the Value of Continuity in the 21st Century

S. Ryan Greysen, MD, MHS1; Allan S. Detsky, MD, PhD2,3
[+] Author Affiliations
1Division of Hospital Medicine, University of California–San Francisco, San Francisco
2Institute of Health Policy, Management, and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
3Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
JAMA Intern Med. 2015;175(7):1154-1156. doi:10.1001/jamainternmed.2015.1345.
Text Size: A A A
Published online

Extract

For most of the 20th century, patients commonly received care from a small number of physicians over a long period of time. Both generalists and specialists followed a large panel of patients in both the ambulatory and hospital setting for many years. In the United States, physicians' first real experience with continuity came during postgraduate education with longitudinal experiences called “continuity clinic.” Residents followed their “clinic patients” until they left the residency, passing their cohort onto the residents who followed them. Continuity was a core attribute of medical care, prioritized by both patients and physicians as a display of commitment. Since the turn of the century, a growing number of forces have disrupted this continuity, both over the long periods of time as outpatients, and even for a single episode of care during 1 hospitalization. In 2015, patients have a much harder time answering the question, “Who is your doctor?” As physicians (and sometimes patients) who have practiced in both inpatient and outpatient settings, we ponder the natural corollary of this practical question: Is the “old continuity” of the 20th century dying off?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

997 Views
2 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Ensuring Continuity of Medical Care

brightcove.createExperiences();