Medicine’s Missing Link

DoctorandtheDollI’m reading a fascinating book at the moment.  I’ll review it on here once I have finished it, but for now, I just want to write about an issues it has already raised for me about our medical system as it is presently.
The book is written by a doctor.  It’s about being a doctor in the States and the ways things have changed since he started being a doctor.  It’s a similar story to what I’ve heard from friends here, who are specialists and GPs, too.  Medicine isn’t what it was.

What ever happened to that old fashioned community stalwart:
‘your’ local doctor?

I used to have a GP, but then I moved far away from her rooms, had babies, moved on with life. I started going to the super clinic close to our house.  It was convenient to take the kids there, cheaper by far and had on-site x-ray and various clinics, as well as a pharmacy.  Every time we went, we’d see a different doctor.  Half of our allocated fifteen minutes would be spent with the GP trying to decipher what the last doctor had recorded in the notes.  So I would tell them why I was there, what we talked about the last time, where it was at, as I recalled it.  If the kids needed to be examined, or a script written, it would happen next.  But more often than not, the worries that had taken me in to the GP were met with “she/he seems happy, it’s probably nothing”.  I would leave, no less worried and even more annoyed for the time spent incubating germs in the waiting rooms.

As seems to be the story shared in mother’s groups across the country, sometimes, at the big clinics, things get missed.  My ‘happy’ daughter was actually suffering from severe ear infections.  Without treatment, scar tissue formed across her ear canal rendering her deaf on one side. I had frustratingly visited the clinic with her several times, enduring that patronising glance (some) doctors give mothers.  Each time, asking about her ears. Each time, they looked in her ears, smiled at her and said she was fine.  When her speech began to change, we sought alternative help. An ear nurse specialist took a look with a microscopic camera, tested her hearing and explained what was going on.  If the doctors had ‘known’ my girl, they would have recognised that a smile didn’t mean she was happy. It meant she was being polite to the grinning doctor.  If they had known me, they would have understood that I wasn’t being a neurotic mother.

We have since moved again.  Enter, a new GP, close to our home but not part of a clinic franchise.  She is getting to know us and learning our back story.  It’s a relief to have a relationship with a GP again, someone to take care of all the little bits and pieces that would otherwise be missed.  The niggles, the ‘normal’ wellness issues of a family.  It’s great to know that she is receiving all the correspondence from my specialists, that she is being copied in on test results, referrals, discharge summaries.   For the first time since I got sick, I am less worried about keeping track of all my own records, I know that she is onto it all, taking primary care of my health, in the old fashioned way.

When did it all change? It used to be this way!  Everyone had ‘their doctor’, who if necessary, would communicate with anyone who needed more information.  Their doctor would be the one to refer them to specialists or hospital if needed, the communication channels would be clear, simple, unclouded.  The only person deciphering their own notes was them. The only person other professionals needed to contact, was them.  When we super-sized community medicine into super clinics, we lost something so important.  To ‘know’ a patient is to be able to make better assessments of their situation. Perhaps, knowing a patient also helps doctors to care for their patients, to see them as more than another fifteen minute walking infection risk in a busy, busy day.

In the book I am reading, Brendan Reilly, an Internal Medicine specialist, expands on the issue from the point of view of the ‘hospitalist’ doctor;
“We’re caught in the middle of an

It’s a frustration patients all over the world, feel.  Dysautonomia can affect all organ systems controlled by the Autonomic Nervous System.  We don’t fall neatly into any one sub-specialty.  Depending on the presentation of our autonomic dysfunction, we will have any combination of various specialists.  Neurologists, Opthalmologists, Cardiologists, Endocrinologists, Gastroenterologists, Urologists.  Coordinating all of these in the past, would have been your local doctor.  Your General Practitioner.  Here in New Zealand, depending on your district health board, (and it seems on your particular pathway into the health system) you might have been appointed a General Physician.  General Physicians are part of the Internal General Medicine team of the hospital.  They see long term patients who require care from more than one sub-speciality.  The are the problem solvers, the diagnosticians. They should trouble shoot your symptoms, find the cause of your ills, devise a plan for your care and coordinate with your specialists and GP.  If you are with a clinic, however, your letters may never get in front of the same person. Your care, as a result, may well be compromised.

I don’t know what the solution is.  Medicine is making big advances all the time, things are changing; the way that care is delivered is being re-designed all the time for better cost effectiveness, among other objectives.  But are these changes helping the increasing numbers of people with multiple co-morbidities, long term systemic chronic illnesses?   The reason I returned to the pricier option of a local GP, was because I needed to know that the communication channels were clear and straightforward for all involved in my care.  It was a good move.  It’s been, not so much back to the future, as forwards to the past. And while it is still possible to have a local doctor, in rooms one block from my house, I’ll be staying with her. She’ll be ‘knowing’ me and my family.

I found this quote when I was looking for the classic Norman Rockwell image I used for this post.  It comes from the Penn Medicine Newsletter:

doctoranddollsallysapega

I’m curious:
Do you have a local GP?
  Why or why not?
Do you see the same one every time?
Are you happy with how that works out for your overall care?

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