Please let me see my lifelong doctor

Paco Miralles

If you are a reader, likely, you will always go to the same hair salon, and surely you will like to be attended by your usual hairdresser. If you are male, you probably also appreciate finding a familiar face for cutting your hair, avoiding having to explain the type of cut you want every time. It’s even possible that on some occasion people delayed their visit a few days when they learn that the person who usually serves them is on holiday. This tendency is present in other sectors. We generally like our hair, our nails, our fish or our fruit to be dispensed by "our" trusted person and we are not often willing to change stores.

With this very rational and logical approach, I am surprised that a recent article published in the British Medical Journal has reached such importance outside the healthcare environment. The work shows that patients who are followed by their usual doctor have less risk of death. It’s similar to the likelihood of finding green tomatoes in our shopping bag if our greengrocer knew us for a lifetime and is well aware of our preference for ripe tomatoes.

The results of the study come as no surprise to many people and me. What worries me is that something so commonplace has engaged public opinion. It’s as if we'd marvel at a study showing that patients who don’t smoke have a lower risk of lung cancer. It’s reasonable that a doctor who knows his patient for having lived with his morbid process for years is more agile capturing small changes in his symptoms and neglecting the noise generated by unconnected or subjective symptoms of the patient that often lead only to unnecessary tests with risk of producing collateral damage (in medicine iatrogenesis means health damage caused by a medical act).

Precisely, one of the most important current problems in the health system is the overdiagnosis and subsequent overtreatment of processes that in their natural evolution would not have influenced the patient's mortality. The term overdiagnosis became famous in 2011 with the publication of the book "Overdiagnosed; Making people sick in the pursuit of health". Books like this may seem somewhat alarming or excessive to the general population, even some pose them as a government condemnation to try to curb health consumption, but the reality is crueller than fiction. The overuse of the health system logically leads to an increase in medical errors by mere probability by increasing the number of actions (although they are also more likely to increase due to the fatigue of professionals facing futile activity). These medical errors are already the third cause of death in the USA after myocardial infarctions and cancer, also causing more deaths than the sum of bronchial processes, suicides, traffic accidents and violent deaths.

Aware of all this, health institutions and scientific societies have developed different initiatives such as "Choosing Wisely" recommending ways to avoid treatments or diagnostic tests worthless in certain situations. It’s precisely in fragmented care with the assistance of multiple specialists, a widespread situation in elderly patients with chronic pathology. Here, there is an interaction of a higher number of actors with the consequent risk of increasing the number of diagnostic tests and treatments, sometimes of little clinical utility.

Are we still surprised that patients whose morbid process is followed by their lifelong doctor have a lower risk of death?

Link to the Doctor Miralles blog