How Many Specialists Does It Take to Screw in a Lightbulb (or Screw You Up)?

By:  Dr. Mark Lachs

We have talked a lot about primary care doctors, otherwise known as your family doctor, and how to make your office visits more efficient. Here, I want to talk more about specialists, which raises a separate series of issues for people who are aging.

The explosive growth of specialty and subspecialty medicine has provided huge health and quality-of-life improvements for many Americans. Subspecialty medicine is in large part responsible for our “age wave.” Many recipients of subspecialty care are alive today because of highly trained doctors who discover and treat a wide range of illnesses or conditions. Specialists can detect early colon cancer or insert stents to open narrowed arteries. And when you think about the wide array of health conditions that are now considered treatable or preventable, you realize that we need specialists because there’s simply too much medical knowledge these days to fit into one doctor’s head or proverbial black bag.

With the inherent need for many medical specialists, if you have lots of doctors, there are many places where things can break down. Ultimately, the buck stops with you (or one of your loved ones or caregivers) as the repository of all medical information. You must be ultimately responsible for the flow of information from your primary care doctor to your specialist and subspecialist – and vice versa. It can get complicated. The older we get, the more specialists we might need.

Primary Care Doctors and Specialists

1. Don’t assume that your medical information will travel with you from primary care physician to specialist.

In fact, assume it will get lost! My suggestion: be your own courier. Ask for a copy of your physician’s consultation request form so you can make sure the specialist sees it. Especially when you are seeking a diagnosis, you want to take extra measures to facilitate the flow of information.

2. Make sure the specialist knows what medications you’re taking and about your medical “greatest hits” list.

Carry around a list of your medications and make sure you show it to the specialist. Make sure he or she knows what you’re taking and what conditions you have; any treatment he or she prescribes could conceivably interact with what medications you’re already on, or with the diseases or conditions you have.

3. Make sure information from the specialist flows back to your primary care doctor.

In the same way that you have to make sure the specialist understands why you’re seeing him or her, you need to make sure that whatever he/she did or discovered is conveyed back to your regular doctor. Feel free to ask the specialist when and how your medical findings will be conveyed to your primary doctor – but don’t rely on this happening. Often, in busy practices, the sending of information is often delayed.

4. Be your own medical records and radiology department.

Medical information technology has come a long way in recent years and quite often, your medical information will be available to the treating physician via an electronic medical record. However, there can be lapses in record keeping and not all of your physicians may be sharing the same electronic record system. Therefore, whenever you have blood work or a test – especially anything non-routine, such as a stress test or an MRI – get a copy for your own records which you can use to show any treating physician.

5. Don’t leave your health to the specialists; you still need a primary care physician.

This is true for an overwhelming majority of patients, and the need becomes more urgent as we get older. Subspecialists are key to helping you stay healthy, but you still need a ‘traffic cop’ through whom all information flows and all specialty care can be coordinated. Consider your primary care physician as the gatekeeper or orchestra conductor for your care.

Subspecialist As Your Primary Care Doctor

With all this said, however, there is one exception to the above guidance – if a single chronic illness is the major obstacle in your life, it is not unreasonable to have an internal medicine subspecialist also act as a primary care doctor. Patients with a specific chronic disease may develop additional or unusual primary care needs that a subspecialist would be more attuned to – conditions that are more likely associated with the chronic condition.

And finally – when you deal with the world of subspecialty care, how do you assess a good patient-doctor fit? Whereas in previous blogs I have discussed the importance of communication, customer service and chemistry between you and your doc…to assume that you will have this with every doctor who comes in contact with each one of your body parts is both statistically improbably and pragmatically undoable. Remember to put things in perspective – be willing to give ‘Dr. Gruff Bedside Manner’ a little latitude if he can figure out what’s wrong with you after everyone else has failed.

Innkeeper, gatekeeper, call us whatever you like; it’s far preferable to “six characters in search of an author,” which is what much of medical care has become for older people these days. That’s what happens as we interact with more and more doctors, with no single one flying the airplane.

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