September 17, 2019

Notice how medical specialties are exploding?


By John Guy LaPlante

It’s amazing how many more kinds of doctors are treating us. Specialists and sub-specialists! Wow!

If better care is the result for us, I’m all for it. I’m not sure that’s always true.

Recently I had to go to a urologist. My first time ever. Too many get-ups during the night!

Later I wondered, How many kinds of specialists like that urologist  have I gone to see over the years?

A dozen at least. Medical doctors. Plus other kinds. Read on and you’ll see for yourself the  wide choices we have now. Amazing!

When I was a kid, there were just two kinds of M.D.s. There were doctors. And surgeons. That was it. I got to experience both.

First was the doctor. Impossible to forget him. As old as my grandfather. He came to our tenement with his little black bag. House calls were common back then. I was six or seven. I was very sick. A bad cold. Maman worried it might be pneumonia. Often fatal back then. He gave her some medicine to give me. He had visited me before for something else.

He was closing his black bag. We were standing in the kitchen. Maman was at my side. He put his hand on my head and said to her, “I’m sorry, Madame. I don’t think your little boy will live to be 30.”

Can you imagine that? Think of my Maman’s shock. It didn’t bother me much. Honestly. Thirty years seemed so far off. On his earlier visits he must have diagnosed something bad.  Maman never mentioned it. My 30th birthday came and went. Gosh, have I fooled him!

About the surgeon. He was about Papa’s age.  I was eight or so. I remember he was very gentle. He operated on me in his office. I don’t recall his having a nurse. He put me on the table and said, “Don’t worry, Jean-Guy.” That was my French name. ”Everything is going to be all right. You’ll just go to sleep for a little while.”

Then he put a cone on my nose. You know, like an ice cream cone. Then he dripped something on it. And I went to sleep. That was high-tech back then. When I woke up, I felt awful. So sick. My tonsils were out. But I was so dizzy. Tried to vomit. What an awful, miserable experience.

Well, I did check how many specialists we have now. I studied one list. Thirty!  All the way from allergist and anesthesiologist and cardiologist… and on to radiologist and rheumatologist and urologist. Mind-boggling.

And most of the specialties have sub-specialties. That’s really mind-boggling.

And there‘s always a new sub-specialty popping up. The latest, well, to me, is the hospitalist.

Familiar with hospitalists?  They’re doctors who work full-time in a hospital and take over for your regular doctor while you’re in there. They confer with him, arrange your care, and make all the decisions. To say it plainly, your doctor surrenders you to the hospitalist.

It’s said to give you better care. The hospitalist is Johnny on the spot if something comes up. And that makes life much easier for your doctor.  No more hospital rounds. Remember them? When your doctor visited you twice every day you were in the hospital? That seems ancient history.

I mentioned that so many specialties have many subspecialists. Well, surgery has 14. Family medicine has 6. Obstetrics and gynecology have 6. Pathology has more than a dozen. Pediatrics has 20. Psychiatry and neurology have 20. On and on it goes. I didn’t see where hospitalists fit in. All are certified specialties, by the way–you have to pass tests to get to join one.

So, of course, nowadays when you go see your family doctor, also called primary care doctor, that may not be it. There’s a high chance he’ll shoo you off to a specialist of one kind or another.

I’ll bet there are patients who go to half a dozen different kinds routinely. Some to more. The assumption, of course, is you’re getting much better care. This can cost a ton of money, of course. If not for you, then your insurance carrier.

There are others. Nurse practitioners—super nurses. And Physician’s assistants. They’re not M.D.s. Two years ago I went to hospital emergency and was so happy with the care the doctor was giving me. Yes, there in a busy emergency room. He was a P.A.!

And there are others who are fairly new to the game. Physical and occupational therapists. And dietitians. I’m sure I’m overlooking some.

Which reminds me. Have you heard what CVS is doing?  The giant pharmaceutical chain has launched a chain of Minute Clinics. They’re right there in the stores. There are some  30 of them just here in Connecticut. They’re staffed by Physician’s assistants and Nurse Practitioners. They do a whole list of things. An impressive list. Just walk in. Convenient hours. Service with a smile. Medical insurance accepted, of course.  For sure they’ll be all over the country. And I’ll bet copy cats will spring up  in other chains. This must give shivers to M.D.s doing family madicine.

I’m through talking about caregivers in the M.D. “family.”

 Now consider osteopaths. They’re not M.D.s. They’re D.O.s—doctors of osteopathy. They are a small percentage, but it’s growing.

Osteopathy has come a long way. For a long time it was considered second rate. They are considered equivalents of M.D.s now. You’ll find them often working side by side with M.D.s in office practice or the hospital But they’re also trained to D.O. “manipulations”—adjustments to the spine and vertebrae and joints.

I go to a D.O. and like him. Before, I went to another, who after a year or so moved away. A big disappointment. That’s why I sought a second one. But I was disappointed when this one told me he did not D.O. adjustments. Oh, well. He’s very good in the care he gives me. And we have a great relationship. Which is all-important.

Some osteopaths are specialists, too. That’s the phenomenon through medical care of every stripe,

Dentists, for instance. They started out as pullers of teeth. Developed into what are now our highly trained DMDs or DDSs—doctors of dental medicine or dental surgery. I’ve never understood the difference. If there’s one, it’s minute. Depends on the dental school they went to, I think.

Now you can go to a general dentist—also called a family dentist– who will fix a cavity and D.O. other things. . But if you need a tooth pulled, say, he may send you off to a specialist in that. Or to specialists for other problems–endodontists, maxillofacial surgeons, orthodontists, periodontists, prosthodontists, still others. Many of us, of course, really don’t know what those fancy words mean. Including me.

 Podiatrists. Same things. They’re foot doctors. Sorry, they are now foot and ankle doctors. They are not M.D.s. Their D.P.M stands for doctor of podiatric medicine. There are general podiatrists. And many specialize. Some 15 specialties! Makes you wonder how such a small part of our body can have so many specialists.

Chiropractors. Same thing. Specialists in this or that. Some chiropractors, by the way, are calling themselves family care providers. That goes way, way beyond back and neck problems, which is what they started out doing.

That’s just a start. Consider the big grab bag called Alternative Medicine. It includes Naturopathic medicine. Homeopathy. Chinese medicine. Acupuncture. Hydrotherapy. Massage of different kinds. Faith healers. There are others.

 Curious about all this? Just take a look at your Yellow Pages directory, especially if you live in a big city. (If you still have a YP directory. That’s becoming a thing of the past.) You’ll see the incredible variety in every branch.

I know some people go to an M.D. and also one of these others. Playing safe, I guess.

I myself have gone to a long list of M.D. specialists over the years. At least a dozen, maybe more. I suspect that’s normal for an older person. I’m sure I’ll be calling on  others as I move on.

I have also been to dentists, of course. Who hasn’t? And chiropractors and podiatrists. In one way they’re like M.D.s. Some are better than others. Some are excellent. Some are outright bad.

You would think that with all this learning and expertise to back us, our health would be getting better as a nation. And it is. We’re living longer. Better. We are blessed. So often we go for an operation or a procedure and call it a miracle. With reason. Cataract surgery can be miraculous. So also knee or hip replacement. And coronary surgery. And a kidney transplant. On and on. All fantastic.

But as we know, we still have great voids—great pools of people who have zero coverage. Obamacare is a solution to that, impressive as it is and yet, sadly, as inadequate as it is.

It wouldn’t surprise me that we have more kinds of medical practitioners than any other country in the world.

But very surprising, some countries do an even better job. At a lower cost. There’s no arguing that. The statistics prove it. But that’s a different subject.

What’s it going to be like 50 years from now? Just 25 years from now? Will the sub-specialties have sub-specialties of their own?

Washington has just announced that Medicare will now cover end-of-life counseling. Much needed. I’m all for it. I’ll sign up for an appointment. But not tomorrow or next week. No rush yet.

For sure that will become a specialty. M.D.s will train to do just that, period. What to call them? Here’s my suggestion. Finalists!  Appropriate, don’t you think?

Specialists make more money than the family doctor–now called primary care physician–who directs us to whatever specialists we need. Some astoundingly more  money.  That’s one reason doctors gravitate to a specialty, to get richer. It’s an honest motive.  The belief is that this greater specialization gives  us better care. In most cases, for sure. It certainly increases the expense explosively. And it can be wasteful.  You agree?

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