Doctor To Patient: It’s Not My Area

I get calls to review records for people.  They want a neutral set of eyes to evaluate the information.  Usually, the person asking, has seen multiple specialists and doesn’t have a diagnosis.  They are asking me for direction.  Recently, I had a case that stunned me because the client had seen multiple specialists over a 2.5 year period and they had missed an obvious and life threatening condition.

The problem is specialists often don’t look at the whole picture.  In this case, radiological exams identified abnormalities related to another system yet the specialist who reviewed it, didn’t refer to another specialist.  I don’t know if they thought the PCP would pick it up. Or maybe it was not abnormal enough?

I also find that patients get categorized by symptoms .  For instance, if I go to the doctor and have abdominal pain, I will be sent to a gastroenterologist.  If at the same time, I have develop high blood pressure, I will be sent to a cardiologist or followed by the PCP.  The GI doctor, will focus on my abdominal symptoms and not my blood pressure.  I have heard specialities say, when patients give all the symptoms, that only certain symptoms are their area.  But often it is all the symptoms that matter.

I get the feeling sometimes, that patients aren’t believed when they describe a multitude  of symptoms.  These symptoms may not easily fit into the standard of care or criteria for disease investigation.   Patients are shooed out of the office with comments like, “call me if it gets worse” or “there is nothing else I can do for you” or ” I think you should see a psychiatrist.”

I wish it was an unusual occurrence but I have seen it more than I would like.  Our healthcare system has designated the PCP as the person who is supposed tie all the pieces together.  However, the problem is that the PC doesn’t always get all the information from the specialist in a timely manner.  Another problem is if the patient has gone to a specialist outside of the PCP’s network.  Sometimes those notes never make it to the PCP.  Then, there is no way for anyone to coordinate care.

I tell people always to get their medical records.  It is the only way to make sure you have all the information and it can be passed to all medical professionals.  Some doctors will gvie you a copy of the note before you leave the office.  I recommend asking each doctor for a copy.  I also recommend asking for copies of radiological scans.

In the case of my client, everyone had copies of the scans and notes.  The problem was even though certain abnormalities showed up on scans, they were not as abnormal enough and considered as follow up in 6-12 months.  However, no one took responsibility for the follow up.  Consequently, the client suffered for 2.5 years until a doctor happened to order a test looking for something else and revealed an unexpected result.  The good news was there was a diagnosis.  The bad news is it took 2.5 years.  My client was lucky.