Specialists vs Generalists

  Annamaria on Monday

 

Though I write today about my recent experience as a patient in healthcare in New York City, I prefer that you read this as a philosophical discussion, rather than a plea for sympathy from a person who's feeling sorry for herself. Self-pity is a trait akin to the plague as far as I'm concerned. We've all had enough of plagues for the past seventeen months. That said, here is my personal reading of western medicine, as practised at its most advanced level.

 

Imagine if your car were subjected to a dysfunctional system that worked like this:

 

One morning, you go out to your driveway to try to start your car, which worked perfectly well the day before. It won't start. You call road service, and they tell you that you must have a dead battery. They send a Battery Specialist, who comes and tries to recharge your battery. He even replaces your battery. But nothing he does restores your car to operating condition. The battery guy tells you that it must be the starter. He gives you the telephone number of a Starter Specialist. You are charged for this “service.”

You then have to have your car towed to a Starter Specialist. The specialist listens to your experience so far, and she replaces the car’s starter. The car still doesn't start. The Starter Specialist tells you that it must be the spark plugs. She gives you the telephone number of a Spark Plug Specialist. You are charged for this service.

 

You have your car towed to the Spark Plug Specialist, who replaces the spark plugs. But your car still doesn't start.

 

And so it goes...

The Maserati Alfieri!

This is the kind of experience I am having since my previously well-functioning body went haywire.  I count myself as an extraordinarily lucky person.  Until this episode, except for a few temporary and treatable issues, my body has been like a Maserati. All I have had to do is turn the ignition, put it in gear, step on the gas, and it roared ahead. I am enormously grateful for this great good luck that went on for decades upon decades.  Perhaps it is only now that I am experiencing what has plagued others forever—a body that needs a serious tune-up and no luck finding the right place to take it.

 

It might be just me, but…

 

So far, I have been to my primary care doctor going on five times. I have also been many, many times to a physical therapist, an acupuncturist, a therapeutic masseuse, and to a spine surgeon, and two pain doctors. I have been CT-scanned, MRI-ed, EKG-ed, x-rayed multiple times, and I have had my blood pressure taken scores of times.

 

The latest advice I have gotten is that I should see a neurologist. I have also been warned that getting an appointment with a neurologist in New York City at this moment might take months. (It is interesting to me that common expression is “see a doctor.”  If only.  Though a couple of docs I have seen are quite good-looking, “seeing” them so far has not been all that helpful.)

 

It is obvious to me that nobody knows what I really need, and there does not seem to be a person who understands enough about a whole human body to help me figure out what is going on in mine.

 

Americans have heard constantly over the past couple of decades about the rising cost of healthcare in the United States. Healthcare is more expensive here than anywhere else. In the gorgeous city where I live, it is also in its most advanced state. What I am wondering is how much of that enormous cost comes from the fact that there are so many brilliant specialists, certainly able to help people in incredibly useful ways.

 

But…

 

 The first step in curing any ill—medical or otherwise—is to identify the problem. Perhaps there are people in healthcare today whose specialty is Diagnostician.  In other words, a Generalist!  Perhaps it just so happens that the people I have gotten to “see” so far haven’t thought to give that person’s phone number.  

 

I said I wanted this to be a philosophical discussion.  If others are having similarly frustrating experiences, perhaps what the medical care system needs is better-defined problems before people go off half-cocked, trying a string of solutions, running up bills, and getting nowhere.

  

 

Years ago, when I was a generalist consultant in organisational effectiveness, I had a mentor, a brilliant man. He was the head of strategic planning for the world’s largest pharmaceutical company. The company’s issues where existential at the time. His name was Stan Molner. He hired me as a consultant to work with him, mostly because I was not a specialist in one type of problem.  His philosophy, as he expressed it, was: “If you have a problem and you jump to the conclusion that it is the physical plant’s design that is causing the trouble, you will hire an architect. The architect will design a new building. It's the only answer an architect can provide. If you are mistaken about the root cause of the problem, you will end up—at great expense—with a beautiful new building where you can go and live with the old trouble.”

 

YUP!

 

Perhaps this is why they call us patients!

 

In the meanwhile, here is the illustration for this month on my beautiful Rumi calendar!!