When the Specialists are Done

Medpundit has something to say about the docs in the ivory tower, and more:

But, I do know that all too often, when the treatment has been exhausted and the patient ends up in the closer hospital in extremis, the miracle-working specialists are nowhere to be found.

  We see this in the ED more than we want.  It’s usually a patient who couldn’t be cured by a specialist, or even a subspecialist, and the patient is told ‘there’s nothing else I can do’ for your problem (please go away), so the patient comes to the ED, because there’s got to be something that can be done.  Give humans credit, hope lasts.

I don’t blame the patients for this, and the specialists have, IMHO, done all they could once I look into the problem.  Where I have seen this most often is in patients who don’t have a strong Primary Care doctor; they’ve bounced from specialist to specialist without coordination or guidance.  The end of the specialist line comes, and the patient has no-one to turn to.

The demise of the generalist, marginalized by payors, specialists and sometimes patients themselves goes on.  Someone needs to coordinate the care of the patient so that there’s still a chair when the music stops. 

That’s your doctor.