Too Many Specialties Complicate Treatment
I am concerned that the specialization of medicine is leading to a decrease in the quality of care available rather than an increase. I have seen this more and more over the past several months as my husband has had a series of mystifying medical conditions requiring different “specialties” to determine the underlying cause. These specialties do not always play well together.
Let me share a hypothetical example.
- A Neurologist suspects the symptom is suggestive of an Orthopedic disorder. He won’t initiate a treatment plan because he does not want to offend his colleague or be accused of practicing outside the scope of his specialty. Instead, he refers the patient to an Orthopedic specialist for a consultation.
- In our area, Orthopedic appointments are in short supply, and it may take as much as three months for an office visit. Meanwhile, the symptoms get worse. The patient eventually sees the Orthopedist and finds out the problem needs to be addressed by Physical Medicine and Rehabilitation (PM&R) instead.
- Another month passes, waiting for an appointment — another set of scans and x-rays. The problem is much worse now when he sees PM&R, who declares that the patient now requires surgery. The patient is referred to Orthopedic Surgery and the problem has yet to be resolved or treated with a conclusive plan.
Current Complaint Takes the Lead
My husband has, unfortunately, been in the hospital a lot this past year with unusual symptoms. We use a medical center for his care that is very specialized. Upon admission to the Emergency Department (ED), the ED team drives the treatment plan, admitting him if they can’t solve his immediate problem. On admission, another team accepts him as their patient based on his primary diagnosis for that visit. That team coordinates his care and pulls in other medical specialists to address secondary complaints. His follow-up goes to his primary care doctor at discharge, and the team admits him. Since Lynn had four admissions this year, four teams are following him for four separate issues.
Primary Care Physician Coordinates Care
You can imagine how if I kept all those appointments, how costly it would become, not to mention how confusing. Instead, I prefer to use his Primary Care Physician (PCP) from Family Medicine for all his treatment plans to maintain a sense of consistency. She works at the same facility and is excellent at sorting out the drama between the medical and surgical teams. She is also terrific about consulting me through email and phone about his condition and supports me in not making unnecessary trips onsite to her office.
Why Isn’t Neurology the Lead?
While I’m pleased with our PCP, I must admit that the professional I think should be in the driver’s seat coordinating Lynn’s care is his Neurologist, but he isn’t. I don’t understand his hands-off approach. I think the Neurologist should case manage his care. From my way of thinking, Multiple Sclerosis affects EVERY organ system of the body. Nerves leave the brain and travel throughout the body, right? That means all body parts are affected; therefore, the Neurologist should be familiar with the entire body.
- Why is it that a Neurologist only focuses on the nerves themselves?
- Why aren’t they interested in how all the organs are affected?
- Why are they not acting as the commander-in-chief of the army of specialists gathered to fight the effects of MS that are attacking the multiple systems of my husband’s body?
When Lynn goes to a neurologist appointment, he has his reflexes tested, his eyes checked, and new neurological symptoms explored, but the neurologist does not ask about any changes elsewhere.
Shouldn’t a Total System Review Be Part of the Assessment?
Why doesn’t the Neurologist start each appointment with, “Tell me what’s different about how your body’s functioning since our last visit. Include anything you might have noticed that is different that affects any part of your body that is consistently reoccurring or has been a concern to you. I am also interested in any emotional or mental health changes you may have encountered.” Imagine what he might find out if he asked an open-ended question like that.
MS has so many vague and often misunderstood or unknown symptoms that go unmentioned that only a Neurologist might recognize it as a problem. However, how many Neurologists bother to explore if they are present? I know ours has never said one word. Why isn’t part of treatment for a condition like MS incorporating an explanation of what could happen or what to report as new symptoms? So many patients have symptoms they never know are related to MS until they come to a website like multiplesclerosis.net and suddenly realize they have a significant symptom.
Patient Care Should Incorporate Team Conferences
I hope that the medical field will one day consider treating patients with chronic complex conditions from a comprehensive standpoint using a team approach and a leader to coordinate their efforts. Currently, each specialist does their own thing without talking to others.
- Each physician has treatment goals for the patient’s health that impact the outcomes of other medical conditions, but they fail to share those goals with other teams treating related aspects of the patient’s condition.
- Different teams prescribe medications. Although the medications may impact the entire body, none of the different medical teams discuss changes in medications and how a change in one drug might impact another when a significant drug regiment change is occurring.
- Symptoms are identified that imply complications that cross over between body systems. However, the specialties neglect to share the information with each other; therefore, only one specialty takes appropriate intervention measures.
Why aren’t they all sharing information? Maybe that would be just too much, right?
This article originally appeared on Multiplesclerosis.Net by Health-Union, LLC, and has been reposted with permission.
