We need a healthcare system that explicitly allows for two other specialty tiers that (at least in the US) informally exist:
1) the specialist internist (a PCP for specific diagnoses and complex cases that a “generalist internist” cannot possibly handle well)
1) the specialist internist (a PCP for specific diagnoses and complex cases that a “generalist internist” cannot possibly handle well)
2) Super specialist specialists. The handful of -its who exclusively see patients with the same diagnoses, like my neurosurgeon.
He was able to diagnose in 24 hours what 30+ MDs had failed to see. Because for him the “weird” and “rare” is what he says five times a day. If you have one of the handful of conditions he specializes in, he can save you a decade or more of frustration.
A big part of why medicine failed me (and so many others) is that my PCP and neurologist assumed that if the answers existed, they had them, knew them, were taught them. It’s only in retrospect that I realize my neurologist was ALSO a generalist.
Cases like mine—severe, complex—should be escalated to a class of internists skilled in diagnosing and managing complex cases, and working with networks of highly specialized -ists for those conditions.
There is truth to the idea that medicine has become too specialized. But I also think there are domains where medicine is not nearly specialized enough—particularly “rare,” emerging, or rarely diagnosed conditions.
Where there is no clear-cut standard of care (yet). The only way to learn/get good is to see the same type of patients over and over again until the weird/idiosyncratic becomes run-of-the-mill, a recognizable pattern.
The Mayo Clinic is NOT IT. And it keeps proving that it is not it, over and over and over again...
More than anything, we need to create stronger incentives for people who love offroading, taking the hardest possible paths, and innovating to enter medicine. I don’t know where those folks are now, but they are not where the hardest problems are.
That’s not exactly true...I think our problems are actually fairly simple in concrete reality. Our main problems are conceptual/paradigmatic.
I wish someone would give me the keys to $20 million.
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