Every chance I get, I do a grand rounds with pediatricians and other PCPs to promote what you might call Allergy & Asthma 201, and also welcome as many residents as is practical for rotations in my office. The reason is straightforward—I have plenty of new patients who need the specialty care that an allergist can provide — both my accountant and I are happy to have them — but many new patients arrive later, and sicker, than they should.
The PCPs understandably are trying to treat patients themselves, but they lack the expertise (and time) to do an adequate history, they misunderstand the tools, and they fail to follow up on treatment that might or might not be working. By reaching out to PCPs, I’m not trying to turn them into allergists. Rather, I’m trying to make them appreciate that they will better serve their patients by recognizing what they don’t know and can’t do.
What do I see in a typical week?
Children with chronically runny noses who have been treated with regular courses of antibiotics and are starting to show signs of lower airway distress, such as coughing and wheezing. Children and adults who wheeze at home, but who improve at school or work, and vice versa, but who have never been asked about the whether the roof leaks in one place or the other. People who grudgingly follow a tiresome medication regimen (or not), and have never been taught to use a peak flow meter or consider changing bad habits. Patients who swear they are controlled but had to go to an emergency room. The most dispiriting are the kids who show up regularly who aren’t hitting their growth targets and whose parents are despairing because they have trouble feeding the child because they are “allergic” to a large range of foods according to a broad and misunderstood panel of results from blood testing.
The list could be much longer.
One of the problems allergists face as a specialty is that our numbers are graying and shrinking. Fellowships are dwindling and many of those who are training go into research. We need good researchers, of course, but it is at the clinical level that much of the work gets done. Effective allergy and asthma treatment rely on behavior and environmental modification as well as medication; patients and their parents have to shoulder some of the burden of effective treatment, but they have to know what to do. The structure of our medical education system being what it is, I don’t expect the numbers of training clinicians to surge. Therefore, it is incumbent on current specialists to leverage our expertise by reaching across the divide to PCPs.
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