When too many cooks … the problem of too many consultants

Recently I communicated with a patient’s mother in another state.  She had great angst when a series of subspecialists gave her different opinions on the ongoing plan for her grown son. This problem happens too often in 2016.  Each subspecialist seems to see the patient solely through the prism of their expertise.  We have seen one consultant call 3 or 4 other consultants. Many hospitalists will tell you this story.  At many community hospitals the consultants do not just provide an opinion, but rather they write orders.  This practice leads to confusion and sometimes conflict amongst the subspecialties. Several years ago, I watched a video in Canada about this problem.  The video discussed a patient with COPD, left heart failure and chronic kidney disease.  The patient told the story of how each subspecialist gave different opinions on medications.  When the patient switched to one good internist, his management was much more clear and the patient benefitted. Too many consultants without a designated lead physician resembles the sound that you would get from jazz musicians who each want to play their instrument without regard for the other instruments.  Great jazz ensembles communicate, and generally have a conductor. Thirty or so years ago, during the heyday of managed care, internists and family physicians (both specialists in their own right) received the label of gatekeeper.  We always hated that term and the implications that it carried. What we need fro...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs