Today it is not uncommon to hear, “Who is a physician I should go to? I am having pain in my abdomen and it is not really in the pelvic area but a little higher.”
Who do we go to? Today in the era of the super specialist it is easy to pick a physician when you know what is wrong with you and you know who to pick. A patient can literally go to a half dozen different physicians, all of who can tell you what is not wrong with you if “what is not wrong with you” happens to be in their specialty. Unfortunately; if it is not, you pick another physician and move on.
What is the problem with specialties? In 1975, one of my family practice residents at the University of Minnesota late on a Friday night came to me and told me one of his patients was going to die this weekend and he did not know what was wrong. I said let’s go figure it out and see what we can do. I saw the patient with him and read the string of six different consultations by six separate specialists. Each consultation was nicely done. Please note that 1975 is the time frame prior to CT’s, MRI’s, PET scans, exotic laboratory work and the myriad of diagnostic testing the patient is put through today.
The patient in question presented with abdominal distension and pain in the abdomen radiating into her chest, back and pelvis. She had continual vomiting over the past three days which was now bilious in color with no evidence of bleeding from either end of the GI track. The rest of the review of systems was pretty much unremarkable.
The ob-gyn consult did not find anything remarkable in her pelvis. The internist did not find anything of interest in her chest. Nor did the cardiologist on examination of her heart. The orthopedic surgeon did not think the back pain was of a boney origin. The gastroenterologist said her GED was normal. I do not recall who was the last specialist to see her. Each specialist though had very nicely documented what this patient did not have.
On my examination of the patient following talking with her it seemed to me that she probably had a straight forward bowel obstruction. Earlier flat plates of the abdomen did not reveal air fluid levels but the films on this day did. We operated on the patient lysing some small bowel adhesions from a previous abdominal surgery and the patient did well and went home three to four days later. We continued to use her as a teaching example in which multiple specialists did not make the diagnoses when it was beyond the scope of their specialty.
I constantly told my residents that when it comes to looking at the whole patient, you are the gold standard. It is not a bunch of specialists with each one tied to their own little piece of the patient. Cases such as this help the young family practitioner understand their value in a patient’s total care.
Why is no one going into this specialty?