The Doctor-Patient Disconnect

A big part of the modern problem, the disconnect between the medical profession and the lay public, is specialisation - the modern specialist does not know, or think, of anything outside of his/her specialty and the GP is discouraged from applying his, or her, general knowledge and judgement, to order appropriate tests. Rather than assessing the patient's complaints and addressing / investigating the problem per primam, the family MD's first 'knee jerk ' is to decide what type of specialist the patient needs: thus the MD functions as a referral source, not as the reliable expert which, once, he was supposed to be. Aging and your Hormones is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. The specialist, in turn, often decides that there exists some aspect of the presenting complaints which fall outside of his/her designated area of expertise and refers on, to another discipline. So the patient bounces from specialist to specialist, with weeks or months waiting for each: the family doctor waits, for the specialist's report and there is no-one to assemble and interpret his. or her, puzzle. Come to think of it, there IS a palpable reason for at least part of the problem. It has to do with our modern training methods: in the old days, everyone - all medical students, that is - got identical instruction (variable to some extent, from school to school, but uniform within each school). Thus the basic knowledge content of medical training, through to the end of internship, was as broad as possible and all were ready for family practice when the internship was completed. Specialisation was not permitted until the MD degree had been obtained, so all specialists were firmly grounded in the basics of the trade and all had a wide-angle view of humanity and of the profession. Nowadays (within the past three or four decades) training has been modified, such that many students select a specialty even before they enter 'first year' and their wishes are pandered to: instead of broad, 'wide-angle' instruction, the nuances of their chosen specialty are emphasised and 'generalist' information and 'modus operandi' tend to be ignored. Thus we are producing a plethora of specialists, who know everything about their own subjects, view non-specialist information as unimportant to diagnosis and therapy, consider any unrelated symptom as a reason for on-referral to another specialty and present a narrow, myopic opinion, relevant only to their own small area of expertise. Even general internists are in short supply/hardly exist, any more! In the meantime, the family physician, similarly trained as a 'family practice specialist', is rendered subjugate to the system, browbeaten by both the 'College of Medicine' and the 'Ministry of Health', stripped of self-confidence and initiative and in effect, impotent to function as a decision-maker. He/She has been educated to act as a referral source for the specialties…… If a patient happens to present a complicated history, he (or she) might be referred, simultaneously or sequentially, to a Cardiologist, a Nephrologist, a Hepatologist, a Gastroenterologist and an Endocrinologist - each referral is usually set for 4 or 5 weeks from the referral date, so that the last specialist report sometimes arrives on the family MD's desk MONTHS after the patient first complained……… As one of my friends exclaimed, 'By the time the last opinion has been reported, I'll either be better already, or I'll be dead ! We need to pressure universities to return to the ways of the past: we need a system in which all MDs are trained, lateral-thinking generalists - specialisation should be permitted only after at least three years of general practice, following internship and the Family MD should be educated enough to be effective in discussion with the specialist. If this change were implemented, we would: Encourage initiative and responsibility, in family practice, Permit the individual specialist to think outside his own box, Shorten 'final diagnosis' time, Enable the 'generalist' family MD to collate and interpret specialist reports to the patient's advantage and Improve the efficiency and cost of Healthcare. https://choosingwiselycanada.org/recommendation/endocrinology-and-metabolism/ Aging and your Hormones is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.