Should the Discipline of Family Medicine Honor Its Commitment to the Health of the Public by Defining Its Central Mission as "Continuity of Care" or as "Improving Health Outcomes"?

Abstract

The discipline of family medicine has historically focused on longitudinal patient relationships and continuity of patient care as essential pillars of the discipline. Growing corporate involvement in health care and the drive for access and convenience challenge the value of the continuity relationships. Continuity of care is not on the roadmap of many newer initiatives in health care that strictly focus on health outcomes. The question arises whether family medicine should focus its commitment to society on the continuity relationship or whether it should grow that commitment to include outcomes, not only to address corporate interests but also to acknowledge patient and community needs. The evidence supporting both continuity of care and primary care effectiveness is robust and particularly relevant to family medicine. The question was debated whether the continuity relationship is practical or effective without being grounded in the outcome of improved health. If continuity stands as its own outcome, do family physicians still commit to health for patients, or is it enough to simply provide ongoing, continuous, longitudinal care? The case was made that every aspect of the relationship with patients depends on health being at the center. Family medicine leaders recognize the value of continuity as a foundational aspect of the specialty, but continue to debate the value of continuity as a means of improving health outcomes for patients and communities.