There is no Team in Medical Specialist
Posted Tue, May 25, 2010

Peter (not his real name) developed a red spot on the tip of his nose 2 years ago. He is now 16 years old. Last week the spots became more red and formed 2 blisters. His mother took him to a board certified plastic surgeon. The surgeon told the mother he didn’t know what the lesion was but that he could cut it out. He advised them Peter would be left with a permanent scar on his nose.
A 30 year old man told me every time he sees his dermatologist the doctor removes a mole from his body. A mother told me her dermatologist removed 6 moles at 6 different times from her 16 year old son. The moles were said to be “suspicious”. The moles were all benign!
A man came to me and said he had a lesion removed from his face. The doctor told him the biopsy showed “it was nothing”!!
A patient with arthritis was seeing a rheumatologist. He saw her monthly and did repeat blood tests each month which showed no change in her condition.
The chief of orthopedic surgery at one of our Chicago university hospitals billed a patient for a complete physical exam while she was in the hospital. He never saw her!
A patient went to a plastic surgeon asking for help with her neck. He did not comment on the anatomic abnormality which caused her neck appearance or on the obvious bone erosion of her chin due to a 35 year old chin implant. He offered to raise her eyebrows and do a facelift. (I raised my eyebrows too.)
An allergist did repeat series of allergic skin tests in a patient with eczema. The patient cleared in 2 weeks with a prescription for antihistamine.
The stories go on and the conclusions are the same. Many patients experience inaccurate diagnoses and needless care at the hands of medical specialists. The reasons are numerous and include the fact that payments are higher for performing a procedure instead of using diagnostic skills; reduced reimbursements lead to doctors spending less time with patients; failure of any effective oversight for medical care.
Yet the most overlooked cause may be the patient. Last week I did an informal survey of 10 consecutive patients. I asked each if they had seen a primary care doctor in the past 3 years. None had done so! In fact most did not even have a primary care doctor. Patients are self-referring to specialists, which raises the cost of medical care and deprives a patient of the managing expertise a primary care doctor brings. Most of us doctors spend little time in hospitals and because of that we rarely see each other. We certainly don’t talk to each other about our care for a mutual patient or whether our treatments conflict with one another. We don’t discuss what is best for the patient. This is the role of a primary care doctor. The patient who thinks the specialist is smarter than the primary care doctor is cheating himself. He exposes himself to abuse of possibly less ethical or less concerned specialists. He not only gets poor care, he deprives himself of the opportunity to get proper care. The team concept simply doesn’t work without a manager. Following my own advice I made an appointment to see my primary care doctor today. I suggest you do as well.


Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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