Our Unsustainable Culture of Medical Specialization – Neal Emery – The Atlantic

A thoughtful piece on the challenge to provide more integrated care to people with multiple chronic conditions (increasingly common these days), given the trend over the past decades of greater specialization. Quote:

…. benefits [from specialization] break down in the face of problems that cut across the divisions; namely, people with multiple chronic diseases. These patients, said to have multimorbidity, see a different specialist acting in isolation for each condition. Additionally, because clinical care guidelines and randomly controlled research trials typically focus on patients with only one disease to avoid confounding variables, specialists rarely know how treatment they administer interacts with other concurrent treatments. This fragmentation results in frequent adverse reactions to drug combinations, redundant or ineffective care, and overall poor health outcomes.

Not only do multimorbid patients receive suboptimal care, but the unnecessary hospitalizations, redundant tests, and disjointed care they receive put disproportionate pressure on our health system. A 2010 report from the Robert Wood Johnson Foundation suggests that the 75 million Americans with multiple chronic ailments, a quarter of our population, account for 65 percent of all health expenditures.

Patients with multiple chronic diseases are not an anomaly; they are quickly becoming the norm… 

I do benefit from an integrated team approach for my stem cell transplant, with one of the doctors being a clinical doctor whose role, in contrast to the hematologists, appears more to be looking at the overall picture, complemented by our family doctor. If I had another chronic condition, however, I would likely have similar challenges.

Our Unsustainable Culture of Medical Specialization – Neal Emery – The Atlantic.


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