Over-Specialised Drones

[davidgillon]

My last couple of hospital appointments have left me wondering whether my consultants, and presumably consultants in general, might be becoming a teensy tad of a bit over-specialized. 

When I saw Doctor B a couple of months ago he queried why I had been sent to see him, a shoulder specialist, when I actually had a neck problem. As I had to remind him, with everything manifesting it as shoulder and arm pain we didn’t know it was a neck problem until he’d diagnosed it as one – a diagnosis he had repeated only a couple of minutes before. Do try to keep up, Doctor! This was the same appointment that featured the confidence-inspiring:

Doctor B: Does Jenny do necks?

Nurse: Um, I think so….

Doctor B: We’ll send you to see her, then.

What happened to that referral I don’t know, and I know the paperwork existed because it was in my hand at one point, but I have been waiting for a follow-up appointment with Doctor B. Last week, after the disruption caused by the snow, I had a phone call from the hospital saying they were putting on an extra clinic and could I do an appointment in the morning?

 So next morning I was there bright and early (having skirted the two week old puddle of black ice cunningly left ungritted in the middle of the disabled parking -- I had to wonder if they were trying to drum up extra business?), but strangely none of the treatment room doors showed any sign of Doctor B’s nameplate. So I waited, and I waited, and a suspiciously precise 30 minutes after my appointment was due I was called in, to see Doctor C. I had never met Doctor C before, he had never met me, but to give the man his due he did a thorough job of taking me through the scans of my c-spine and listened when I explained that, because I walk with crutches, anything affecting the use of my arms is even more of a problem than it usually is and it is that combination of symptoms and mobility that concerns me. I seemed to make as much progress in 5 minutes with him as in three or four appointments with Doctor B. Unfortunately that led us into the following:

Doctor C: So what you really need is someone to look at the top and bottom of your spine at the same time.

Me: Yes, exactly. That’s what I have been trying to get people to understand for the last year.

Doctor C: Unfortunately we don’t have anyone here who can do that. 

Aargh! This is the Orthopaedics and Rheumatology department of a hospital serving nearly a quarter of a million people, and they don’t have anyone capable of looking at the entire spine? I’ve been sent back to my GP to ask for a referral to a spinal surgeon, not because I need surgery, but because no one else is apparently capable of looking at the entire spine at once. I couldn’t help noticing the board proudly announcing the specialities of the Orthopaedics and Rheumatology staff as I walked out: Doctor A: Knees, Doctor B: Shoulders, and so on, and it is as well that we have people who can focus on these areas, but somewhere along the line, the idea of treating ‘the whole patient’ seems to have slipped quietly overboard.

You see what I mean about over-specialized drones? 

Comments

[prydera.livejournal.com]

Over here the same phenomenon shows up really specifically in terms of orthopaedics. I don't know if it has to do with the fact that at least in the US, orthopaedists also do all their own surgery or if there's another reason. I haven't noticed the same over-specialisation for things outside of orthopaedics. And my rheumatology experience has been that rheumatologists don't like conditions that don't show up on tests and that they can't just give you a pill to fix symptoms. (Needless to say, in the US rheumatologists are not the doctors who treat EDS.)

[dwgism.livejournal.com]

I know a rheumatologist who resembles that remark, he got seriously stressed about not being able to do anything for me and unfortunately he works in that department. Definitely trying to stay away from him - last time I saw him (long story, but not my choice) he did the old, superceded Beighton test for EDS and got it wrong! Scored me at zero even though I'd just put palms on toes/floor in front of him -- wrong test, done incorrectly, other factual errors in the report - umm...

[techiebabe.livejournal.com]

Oh my goodness! But as someone else who wobbles I would say Stay Away From Teh Surgeons because I once had one - a private one, since I'd been so long on the list that Whipps sent me somewhere posh - and he just said "well, we don't really know what it is, we could cut you open and reconstruct the knee, and there's a 50% chance it would be better afterwards and a 50% chance it won't" (...does that 50% include "might be worse"?)

Can you not ask around to find a good rheumy or osteo who DOES do both ends, and then ask for a referral to them? Surely it's worth travelling for the right treatment? My consultants are spread amid Whipps, Barts, The London, and UCLH... but I don't mind the fact that a hospital trip equals a day out(!) if it means I see someone who understands me and in whom I have confidence.

[dwgism.livejournal.com]

'Stay away from the surgeons' is pretty much what my GP said when I saw her to talk about it, but I'm quite certain I'm not interested in surgery at this stage. What I need is someone who can talk about the combination of cervical disc degeneration, lower back issues and my undefined bendiness and discuss how we control it's progression and maximise my mobility over the longer term -- if that needs to be a spinal surgeon, then so be it, but if it needs to be several people working together then I'm perfectly happy with that as well -- just so long as it happens. Travelling to an appointment isn't particularly a problem, but finding out who I need to see turns out to be a much tougher problem than I'd hoped. I've agreed with my GP I'll see her again in the New Year, by which time she'll hopefully have had the letter from the hospital saying I need a referral and I can talk her into finding someone who can do what I want.