Radical Reorientation of the US Health Care System Around Relationships

Over the past several decades, health care has increasingly been conceptualized as a series of independent encounters (ie, transactions) that can be distributed nearly randomly among health care workers: any physician can round on the patient, any clinician can be on the other side of the telemedicine screen, any resident can cover “continuity clinic.” Although this is a factor in almost all specialties, this transactional mindset that treats physicians as interchangeable parts is particularly problematic in specialties where continuity and longitudinal care play a critical role (eg, primary care disciplines, neurology, oncology, and psychiatry).