title: Emotional effects of continuity of care on family physicians and the therapeutic relationship.
abstract: OBJECTIVE
  To explore conceptions of continuity of care among family physicians in traditional practices, family medicine-trained physicians working in episodic care, and family medicine residents to better understand the emotional effects on physicians of establishing long-term relationships with patients as a starting point for developing a tool to measure the qualitative connections between physicians and their patients.
  
  
  METHODS
  Qualitative descriptive study using focus groups.
  
  
  METHODS
  Traditional family practice, family medicine residency training, and episodic-care settings in Kingston, Ont.
  
  
  METHODS
  Three groups of first-year family medicine residents (n = 18), 2 groups of family physicians in established traditional practice (n = 9), and 2 groups of family physicians working in episodic-care settings (n = 10).
  
  
  METHODS
  Using focus groups, a semistructured discussion guide, and a phenomenologic approach, we explored residents' and practising physicians' conceptions about continuity of care, predominantly exploring the emotional effects on physicians of providing care for a group of patients over time.
  
  
  RESULTS
  Providing care for patients over time and developing a deep knowledge of, and often a deep connection to, patients affected physicians in various ways. Most of these effects were rewarding: feelings of connection, trust, curiosity, enhanced professional competence (diagnostically and therapeutically), personal growth, and being cared for and respected. Some, however, were distressing: anxiety, grief, frustration, boundary issues, and negative effects on personal life.
  
  
  CONCLUSIONS
  Family physicians experience myriad emotions connected with providing care to patients. Knowledge of what physicians find rewarding from their long-term connections with patients, and of the difficulties that arise, might be useful in further understanding interpersonal continuity of care and the therapeutic relationship, and in informing resident education about developing therapeutic relationships, evaluating resident educational experiences with continuity of care, and addressing physician burnout.
authors.affiliation: Queen's University, Department of Family Medicine, Kingston, ON, Canada. kws@queensu.ca
authors.forename: Karen
authors.initials: K
authors.lastname: Schultz
authors.forename: Dianne
authors.initials: D
authors.lastname: Delva
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D004644:Emotions; D005194:Family Practice / Q000193:education; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research