The primary care doctor: someone who knows you

Fans of Downton Abbey were stunned this week at one of the more shocking plot developments in the show’s three-year history: the death of young Lady Sybil Branson, who developed eclampsia after giving birth to her first child.

Besides the drama, the episode contained multiple health messages. One was the danger of preeclampsia,  less common today than in the 1920s setting of “Downton Abbey” but still a serious and sometimes fatal threat to pregnant women and sometimes to the infant as well.

Another was “VIP syndrome,” the tendency for doctors to defer to wealthy and/or important patients and their families, perhaps at the cost of exercising sound judgment. If Sir Philip Tapsell, the eminent obstetrician hired by Sybil’s father, Lord Grantham, hadn’t been so busy ingratiating himself with the aristocracy, would he have paid closer attention to the patient’s condition and heeded her husband’s pleas to get her to a hospital?

Finally there’s Dr. Richard Clarkson, the country doctor who has known Sybil all her life but whose urging for an emergency C-section is brushed aside – with fatal consequences, as it turns out.

Do patients truly fare better with a doctor who knows them well? This is one lesson from “Downton Abbey” that’s grounded in evidence: Having an ongoing relationship with a primary care doctor is seen as one of the best things people can do to ensure their health needs are understood, met and coordinated.

Here, for example, is how the Palo Alto Medical Foundation explains the importance of choosing, and staying with, a primary care doctor:

One of the best ways to make sure you’re getting excellent health care is to have a primary care physician (PCP) with whom you can build a long-term relationship – someone who knows your medical background and understands what’s important to you.

… When you have a physician you know and trust, you feel comfortable talking about anything. And, all your basic care – including routine exams, preventive care and treatment for illnesses and injuries – goes more smoothly and easily. Your PCP also knows when it’s best to refer you to a specialist.

Doctors themselves reinforced this in a survey carried out a couple of years ago by Consumer Reports. Of the 660 primary care doctors who participated in the survey, three out of four said a long-term relationship with a primary care doctor was one of the most important things their patients could do to obtain better medical care.

Here’s more of the evidence surrounding the benefits of primary care:

- In studies carried out in the 1990s, regions of the United States with an adequate supply of primary care doctors had lower rates of premature death from cancer, heart disease and stroke, even after controlling for lifestyle and demographic factors. Later studies also linked the primary care doctor supply to longer life expectancy and decreased incidence of low birth weight.

- Researchers have documented better outcomes for patients who have a primary care doctor as their regular source of care. This seems to hold true regardless of age, health status or whether the patient has insurance.

- People who had a usual source of care were more likely to receive treatment for high blood pressure and elevated cholesterol levels – both risk factors for heart disease – than those who lacked a usual source of care, according to a 2010 study in the American Heart Journal.

- A usual source of care, such as a community health center, also appears to help reduce the effect of disparities such as income, education and environment and improve health for these populations.

Specialists are needed too. Primary care cannot fix everything that ails the patient, after all. But many bereft “Downton Abbey” fans are probably wondering whether one of their favorite characters might have been saved if the doctor who had known her all her life had been allowed to make the decision.