Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care

Background. Continuity of medical care is generally considered to be beneficial to patients. Objective. The aim of this study was to investigate the possibility that familiarity with patients may sometimes discourage case finding. Methods. Extensive qualitative interviews were carried out with a sample of Australian adults with type 2 diabetes, focusing in particular on their experience of diagnosis. Results. Interviews were conducted with 119 participants, 75% of whom supplied sufficient information to enable the coding of whether diagnosis occurred under circumstances of discontinuity. Half of all participants (two-thirds of the coded subsample) had a diagnosis that could be categorized as resulting from discontinuous primary care: hospital admission, change of doctor, patient initiative and/or diabetic emergency. Conclusion. The same circumstances that enhance the management of chronic disease can at times hinder its diagnosis. Primary care service providers may need to instigate more active methods of case finding in order to avoid this paradoxical effect of familiarity with the patient.