Long-term physician-patient relationships are increasingly rare in the era of electronic documentation. Insurance providers often restrict patient selection of physicians, and declining reimbursement for primary care affects the capacity of physicians to maintain long-term care relationships. In a perspective piece published in JAMA Internal Medicine, Adam S. Cifu, MD, of the University of Chicago offered practice guidelines for maintaining long-term relationships with patients.
Having maintained the same panel of patients for 20 years, Dr Cifu set forth the advantages to long-term physician-patient relationships. With a rapport established, patients are more likely to present their concerns in a straightforward manner. Likewise, physicians who become familiar with their patients are able to discern which concerns require serious consideration and which are “[appeals] for reassurance.” In either case, a physician with an established patient relationship will likely provide better-tailored care. Clinical visits run more smoothly with a long-term patient panel, Dr Cifu wrote, and over time, challenging or intimidating patients become less so. Maintaining a long-term patient panel can streamline clinical practice and provide reassurance to patients during care visits.
Establishing a long-term patient panel can be difficult, however. In the first years of practice, establishing lasting relationships with patients can be difficult. Patients may question the expertise of a new practitioner, and clinical decision-making can be difficult for those fresh out of training. As a practice matures, however, these issues typically dissolve. Another challenge to “mature practice” is age, Dr Cifu wrote. As patients age and encounter more severe health issues, a relationship with the physician may make challenging clinical decisions more difficult. Some patients may also hesitate to express perceived “weaknesses” to their long-term practitioner, thus omitting important health-related information such as alcohol consumption or medication nonadherence.
Physicians must remain vigilant in caring for patients over many years, Dr Cifu wrote. Over time, medical knowledge about younger patients may ebb, and if they become complacent, physicians may miss certain symptoms in patients they have seen for many years. Although long-term patient panels have their benefits, practitioners must put in the work to maintain such relationships.
Cifu AS. Long-term physician-patient relationships—persevering in a practice [published online December 3, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.6735