primary care, specialists

Too Much Medical Care?

More from the NY Times– I’m on a kick this week, I guess.

In this column, Tara Parker-Pope, the medical reporter/blogger who writes the “Well” Blog in the Times, critiques her daughter’s medical care.  She describes how her daughter sprained her ankle dancing.  She took her to the pediatrician, who recommended the usual care (rest, ice, compression) and waiting it out.  It was not better after a month, so she took her to a sports medicine specialist.  That specialist ordered an MRI and sent her to an orthopedist.  THAT specialist took a lot of blood and did another MRI, and sent her to a rheumatologist.  THAT specialist did a bunch more tests…but the ankle still hurt.  At this point, Ms.  Parker-Pope called a halt to the merry-go-round, went back to the original sports medicine person, had her daughter get a steroid shot, and she was better in a few days.

She says, I canceled all her appointments with the various specialists, and went back to the sports doctor. We discussed a new approach that focused solely on pain relief. He consulted with my daughter’s pediatrician, and they agreed on a treatment. Within days, my daughter’s ankle had stopped throbbing, and soon she was back to sports and dancing. The cost of this ankle injury had reached well into the thousands of dollars — I had lost track because it was all covered by my insurance.”

I agree, her daughter was a victim of over testing.  However, I feel that the blame lays primarily on the shoulders of the author.  Her daughter’s pediatrician suggested waiting it out- Ms. Parker-Pope initiated seeing a specialist after only a month.  That specialist then participated in my least-favorite specialist behavior- he referred the patient to another specialist.  This is rarely a good idea.  Why?  Because specialists often seem to not know what the scope of practice of a primary care doctor is.  A good primary care doctor can treat many conditions, including initiating a workup for juvenile rheumatoid arthritis, which is what I think the sports medicine doc was concerned about.  

I feel lucky that the vast majority of specialists that I work with respect my opinion enough to send patients back to me for continued workup.  This keeps care from getting too fragmented and allows me to put a stop to the endless merry-go-round of overtesting.

1 thought on “Too Much Medical Care?”

  1. I think TPP is to blame, but I also think it shows a cultural issue–this idea of “see a specialist for everything” didn't come from nowhere. I come from a family where people do that. When my son had reflux, my mother kept asking me why I didn't insist on seeing a pediatric gastroenterologist. After stifling a laugh (because I live in central Pennsylvania, not suburban NYC, and specialists are busy enough here without people like me wasting their time–good luck getting in!) I explained to her that it really wasn't necessary and was well within the capabilities of a regular pediatrician at that point.

    I think spending 4 years in a system (the NHS) with the opposite approach I'd grown up with gave me a more realistic perspective on what PCPs can and can't do. A lot of us here are bombarded with messages that a specialist is always better, and we need to learn not to ask for it.


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