Why Seeing The Same Doctor Could Help To Reduce Your Risk Of Dementia

Seeing the same GP each time sounds like a nice idea. But it is more than that. It really matters.

That’s the message from Sir Denis Pereira Gray, one of the most influential GPs of the last 50 years and a long-time champion of continuity of care.

Simply put, seeing the same doctor most of the time, rather than lots of different ones, could save your life. It has many other benefits too, including potentially cutting your risk of dementia.

Sir Denis, who was President of the Royal College of GPs and then Chairman of the Academy of all the Medical Royal Colleges, talked Brain Health Network through the research on the topic.  

One of the most striking findings comes from a paper published in 2018, in which Sir Denis and colleagues examined 22 previous studies on continuity of care involving 1.4 million patients from around the world.

This revealed that patients who were up to 53% less likely to die in a given period if they saw the same doctor regularly.

Writing in BMJ Open, Sir Denis and colleagues said that this shows that “despite numerous technical advances, continuity of care is an important feature of medical practice, and potentially a matter of life and death”.

The benefits of seeing the same GP

More recently, Sir Denis and colleagues have shown that people with dementia do better if they see the same GP.

For this 2022 study, Sir Denis and colleagues from the University of Exeter and his old practice in the same city analysed the health records of more than 9,000 people in England with dementia.

They found that those patients who saw the same GP over the course of a year were in better health.  Compared to those who saw lots of different GPs, they were:

• 35% less likely to develop delirium
• 57% less likely to develop incontinence
• 10% less likely to be admitted to hospital as an emergency

“We expected to find some changes,” says Sir Denis, “but what was really surprising was how big the differences were. That was completely unexpected.”

He attributes it to better prescribing – the patients with continuity of care took fewer drugs and so were less likely to suffer distressing and debilitating side-effects, as well as potentially dangerous interactions between different medicines.

“The GPs who knew the patients and who felt responsible for them, had a little bit more time to review their prescription list and, on the whole, they reduced it,” he says. “So these patients ended up with fewer drugs and therefore fewer adverse effects.”

The benefits of continuity of care don’t end there. Studies have also found that patients who receive continuity of care are:

• More satisfied with their care
• More likely to follow medical advice
• More likely to take their medicine consistently
• Less likely to end up in A&E
• More likely to say yes to vaccination and cancer screening
• Less likely to be admitted to hospital

GPs, meanwhile, provide better care for patients when they have a good working relationship with them.  Workloads are cut because patients come back less often and, when they do, time is saved because the GP doesn’t need to go through the patient’s entire medical history each time and patients save time not having to repeat their story to unfamiliar doctors.

In fact, according to a study published earlier this year, if all surgeries in England focused on continuity of care, there would be 5% fewer consultations a year. That’s 17 million or so appointments that would be freed up.

Reducing your risk of dementia

Might seeing the same GP cut the risk of dementia? While there’s no research into this, Sir Denis believes it is possibly the case.

He says: “The essence of the prevention of dementia is encouraging patients to adopt a certain lifestyle, for example, not smoking, taking regular exercise and keeping themselves fairly healthy, and that’s just the sort of advice GPs give.”

So, just what is it about continuity of care that’s so beneficial? 

It’s all about trust, says Sir Denis, who in 1973 developed the first practical way to measure continuity of care.

The more a patient sees the same doctor, the more they trust them and the more they are likely to tell them important private information. They are also more likely to follow their doctor’s advice. The GP, meanwhile, feels more responsible for the patient and takes a greater interest in them.

What you can do

The bad news is that it is much harder to see the same GP than in the past. Research shows that just 19% of people see the same doctor today – half as many as a decade ago.

But there two easy things you can do to boost your odds, or those of someone with dementia you care for, seeing the same GP.

• When choosing a new practice, look online for one that says it values continuity of care or uses “personal lists” – the term used when each GP has their own patients.
• When you get a repeat appointment with the same doctor, tell them how much you value seeing them again. “It’s worth saying again and again,” says Sir Denis  

“There’s an assumption that technology is going to save the problems of the health service,” adds Sir Denis. “And it will indeed make important differences but the human side of medicine is also very important. And that, ultimately, care is about human relationships.”

Image credit – Leigh Farmer photography.

Source – Delgado, J., Evans, P.H., Pereira Gray, D., Sidaway-Lee, K., Allan, L., Clare, L., Ballard, C., Masoli, J., Valderas, J.M. and Melzer, D. (2022) Continuity of GP care for patients with dementia: impact on prescribing and the health of patients. British Journal of General Practice; 72(715) :91-e98 Ends