But what you may not realise is it's very good for clinicians too.
A patient I saw a while back brought this home, as seeing real people usually does; it is the point of medicine after all.
But starting where we are...
The NHS abcess that is access obsession (the ineluctable policy focus for an under-resourced service) seems to me to be tacitly supported by a number of false, vague but widely held assumptions, which I have not seen explicitly expressed, but which seem to sit in the background of NHS documents aimed at 'increasing access'.
So at the risk of setting up a straw man, they are:-
1) Clinical work is essentially mechanical. Particular symptoms inevitably mean a particular diagnosis which inevitably means a particular treatment. Ok so I'm over-stating it but an underlying bias in that direction appears to be the logic behind the current penchant for online consulting via apps and questionnaires (as a soft excuse for the real financial one) and the prevailing simplistic approaches to screening and health checks. A scan will sort you out.
2) Following from 1: An adequately trained clinician can follow the mechanics and so all adequately trained clinicians are essentially interchangeable. ie experience does not count so what's the point of seniority payments to GPs for example. (Nod is given to 'complex patients' but still the assumption is that all GPs are equally up to the task, so again why bother with seniority)
3) A shared electronic health record and the generic clinician render personal continuity unnecessary
This to me is the politically-chosen-NHS-poverty-necessity / corporate-commodification-of-medical-time tail wagging the workforce philosophy dog. Reality seems to be ignored in the drive for access; after all, if the above 3 are true, continuity is an irrelevance and the greatest happiness will follow from the greatest access.
So how does my patient's experience illuminate this? A lady in her late 20s develops a nagging intermittent abdominal pain over several months, which she puts down to a muscular cause and, as she is otherwise well, is none too bothered by. However after another mention to her partner it becomes a 'thing' and once a symptom-set becomes a 'thing' it materialises as solid as a snooker ball. It must be dealt with by the system, preferably by being expertly pocketed first time into either 'Normal range, no worries', 'Spot diagnosis, no worries', 'More thought needed, clear management plan, no worries'. Any response that doesn't have the 'no worries' element will result in the ball bouncing around the cushions until it meets a clinician who can pot it because these 'things' crave 'no worries'.
Unfortunately this lady met a centrally driven scheme to improve access, often staffed by inexperienced doctors where there is no continuity or mentor-ship in their role. But hey the doctor was straight out of the GP sausage factory with a fresh MRCGP label and expiry date 5 years hence and had access to my lady's GP record, so all criteria 1, 2 & 3 met - sorted, yes?
When I saw her for her test results a few weeks later she related how she had become progressively more anxious in the consultation as the doctor's inexperience manifested in doctor anxiety as potting this one with 'no worries' was clearly outside their capacity. She began to doubt her own reassuring self-diagnosis; doubts that were confirmed when the doctor ordered FBC, U+E, LFT, TFT, Bone, HbA1c, Coeliac disease screen, Vitamin D, CA-125, abdominal ultrasound and a chest x-ray!
So I saw her on the sixth NHS contact after her initial appointment request (1 Dr, 1 phlebotomy, 1 USS, 1 X-ray, 1 call to book me). We had a chat; she was well, and funnily enough the pain had gone away. I went through her 26 test results (some of the above tests have multiple readings). There were two abnormal results - one of the bloods was slightly out of normal range and a minor benign finding on the scan (which the patient already knew about). But as in a battery of 26 tests with a 5% abnormal cut-off, it's 3 times more likely that at least one of the results will be falsely 'abnormal' than none abnormal and as my clinical assessment put her pre-test probability as extremely low, I was happy to reassure her on that 'abnormal' result. Pocket made 'Patient diagnosis likely correct, natural resolution, tests unhelpful... no worries'.
Had she seen an experienced doctor first off, the pot would have been a swerve around the black of inherent clinical uncertainty putting the mildly anxious red straight into the 'Spot diagnosis - muscular pain, no worries' pocket in such a convincing way that it would have become a self-fulfilling prophecy, even if not quite correct. (The endorphins generated in the patient (and Dr!) by such a shot boost the immune system & sense of well being that ill-ness often just melts away - that's the pharmacology of the 'drug doctor'.) That's one consultation, no tests, no follow-up, same result. Yes experience is literally worth every penny of seniority. (And yes, I do feel sore about this.)
Now, I'm not getting at the doctor; the problem here is a system that de-prioritises continuity. And further, our health system simply cannot afford this way of doing medicine! This doctor may have seen the results but they didn't see the patient again and are very unlikely to in an access-prioritising system. So this doctor has lost out on one of the main tools for effective continuing professional education in the real world - the patient feedback loop.
But supposing my patient had first seen a doctor in a context where the doctor could call upon experience or could see her again? They might have ordered the tests, if experience hadn't intervened, but when they saw her again they would learn they will never need to order those tests in that situation again, as they will naturally re-calibrate their response to that symptom-set. Further they will learn a bit more too about the bit of history they didn't take first time; that the patient wasn't actually very worried - which for this sort of person means they don't need to be either.
As it is, NONE of this learning will occur and the anxious doctor will continue to make the same decisions and the costs to the NHS will mount...
(I did toy with giving my feedback but I don't know the doctor and have no formal professional responsibility there, can't do it face to face & have no idea how it would be received, although I do feedback to members of my own practice & staff I know. But this is my point; we don't rely on people doing a good turn to make sure the aircraft engines are ok - it's there by design.)
Back to the assumptions.
1) is just plain wrong. The technical stuff of history and diagnosis exists within an intensely personal and complex context which modulates it. Inexperience focuses on the technical but as you get more experienced the technical just becomes incidental to the personal, which is where real medicine is really at, or at least should be.
2) is plain wrong. Most newly minted GPs mainly know that they don't know that much; experience counts - it's called 'practise' after all.
3) is plain wrong. Ironically because personal continuity is much, much more information rich than any current IT system and it uses intuitive real-time data retrieval and application.
If the assumptions are wrong then this obsession with access is harmful to both patients, doctors and NHS finances!
My advice to young doctors. Yes you may want to avoid partnership just now, but get a job in a place that values continuity, training and offers mentor-ship or, at the very least, the chance to chat to colleagues about your work at work. It's how you learn and get more confident. Spurn access-only; it won't develop you.
Please yes we need access but we need continuity for the benefit of all concerned and policies that actually make continuity work.
PS I have changed details so neither patient nor doctor are identifiable