There are times when a common cliché may be the best way to describe academic medicine in today’s medical centers. In fact, I have heard patients and their families complain about this, way too often. Simply put, there are many occasions when it seems that there are too many cooks in the kitchen.
When someone gets admitted to the hospital, chronic problems and acute complaints are identified and addressed through a detailed history and physical examination. In order to cover all bases, consultants are called to handle their respective areas of expertise. Since medicine is not a field with isolated silos of thinking, there tends to be significant crossover in thought and in one’s recommendations. This overlap often leads to confusion and angst for the patient, and may slow down the diagnostic process.
Today’s academic medical centers are full of specialty teams, which cover all facets of health care. The composition of these teams include a wide array of practitioners, ranging from allied health professionals, to student doctors training to obtain their medical degree. Also included are those in their postgraduate medical education years. Each constituency serves as a layer within the academic ecosystem. In order to prepare for the patients of tomorrow, they need to learn from those who are ill today. To the patient, each member of the health care team blends together and the hierarchy is easily blurred. Unfortunately, this also provides an opportunity for confusion to the patient and their family.
Patients are finding themselves caught amongst experts with numerous opinions surrounding their various medical ailments. They listen to their endocrinologist; they follow their cardiologist’s advice and make sure to obey the regulations imposed by their nephrologist. What happens when these recommendations begin to conflict? When reality sets in, the patient does not know who to turn to or how to proceed forward.
Despite each specialty aiming to optimize their care in the interest of their patient’s health, this setup does not come without a cost. With each medical field comes a distinct and defined skill set. A skill set to examine, to interpret results and ultimately diagnose. Generally speaking, a consulting service will request their own specific tests and radiologic studies, all of which carry a cost that drive up the overall price tag of one’s hospital stay.
Is this type of health care sustainable in the future? The unconnected pieces of the patient experience must be linked to drive patient care in a productive, yet cost-effective manner. There is an overwhelming sense of confusion by patients and the abundance of consultations provides the opportunity for wasted effort and redundancy. If an individual physician fails to take charge, the patient is prone to further confusion by asking for multiple opinions.
There has to be a more efficient way to provide the care that each patient deserves. Where appropriate, patients want their health care team to serve as a cohesive unit. You do not want the unnecessary stress of deciphering what each doctor is telling you. All you want is to feel better.
Think about it, can a kitchen full of chefs sustain itself over the long-term?
Adam Bitterman is a physician. Shalin Shah is a medical student.
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