Medicine today has become fractured. Primary care does basic analysis of a problem and basic care of that problem, while specialists have become such experts that they often can not see past their own rabbit hole. Few doctors are willing to look at the whole picture, analyze the patient as a person and all the problems presented. When someone takes the time and connects the dots, something special happens, and a path to the future can be found. For many patients, finding the doctor that has the experience to listen, to ask the right questions and to find the source of the problem can take years.
One Patient’s Dots Become Connected
Being a patient can be very frustrating. The other day I had a new patient with back pain, which is a pretty normal complaint for a referral. The patient was referred from an orthopedic spine surgeon who felt the patient was not a candidate for surgery. She was in her mid-30’s and had neck and upper back pain. She also has had longstanding scoliosis, a prominent curvature of the spine, and she had been to a number of previous providers for the problems and wants answers and a solution.
I usually work with a scribe. When I started my visit with the woman with scoliosis, she was fascinated. Within in a couple minutes and a few choice questions, my scribe saw a light in my brain go on and the discovery of the unifying diagnosis that no one in the past had a clue about. The patient had scoliosis, but had been double jointed, had shoulder and knee joint issues, had heartburn, and cardiac problems. She also had siblings that were double jointed. The unifying theme was a genetic-based connective tissue disorder, probably a form of Ehlers Danlos syndrome or Marfan’s disease. This will need to be confirmed by further testing and probably genetic testing.
Finding a diagnosis that connects the dots changes the whole picture of a problem. It no longer is a set of random of events causing pain. Now there is a reason and a pathway to follow to manage the problems. There is also knowledge about the course of the disease and a way to anticipate future medical issues.
Unfortunately, most patients never can connect the dots. Primary care physicians often do not have the time to address more than one problem at a visit. Specialists are only interested in their small corner of the world. My world often consists of looking at odd medical issues. Many times helping a patient means having to analyze the past, ask a few questions, closely listen to what a patient says, and bringing together the story to develop a pathway to the future.
The best patient care is provided by those providers who can see the big picture. Medicine has been fractured by the pressures to see as many patients as possible if providing primary care, or staying in your specialty only for others. Seeing the big picture and connecting the dots is a lost art. Changing lives for a patient means being able to go beyond the ordinary and really trying to answer the all their questions to uncover a long-term solution.
Thomas Cohn, MD
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