Doctors and Levels
Do your doctors have different levels of influence? Mine do. To recap goodness knows I have a slew of doctors and with few exceptions I (maybe just one or two) I really like them. But the thing is now all doctors are the same. It seems like even with the same patient, same issues, doctors have different influences about how a patient will be treated and when.
Here is an example, I have a current issue that is overarching. It affects everything and of course every doctor has a particular way of treating it, all slightly different than others. I have started to think of them in a hierarchy. I have divided them into three area’s conveniently named areas 1, 2 and 3.
These are the top doctors. They overrule everybody else and what they say goes. Unfortunately they are also the least approachable, least friendly and least patient oriented. Fortunately there are only a few in this list. Among them are my cardiologist, heart or chest surgeon, and the pulmonologist. I imagine an oncologist is in this group as well but fortunately I don’t see one of these. Of these my cardiologist is also the best and most patient focused, but she is the least of the three. So if you had something the cardiologist saw as a problem she would have to fight to get someone else to take it seriously. Of the group mentioned above, the surgeon is the guy that calls most of the important shots and the pulmonologist calls (really rejects or accepts) other doctors thinking.
Area 1 doctors can veto almost any procedure for nearly any reason. It is not that they are mean; rather they just want to make sure that any procedure will not complicate the chest region. This has in my view led to some interesting outcomes. For instance I had rather nasty infection at a pump site and I needed it healed rapidly, in order to get ready for an infusion of RA drugs.
The infusion of course is a procedure which they endorsed and gave the go ahead for, even though not a one of them knew one thing about this thing called infusion. So I have to get this healed quickly, I go to the wound center and the doctor says I have just the thing, it is this new kind of topical that promotes rapid healing and drives out infection. But it is new so I need to get cardiac clearance. Well when he calls the cardiologist is not available. So he takes option 2 which takes longer and eventually the thing heals. Then a full two weeks after the treatment he gets a note saying the first healing powder would not have any adverse impact. Well by that time of her letter it had been two weeks after it healed and there was my cardiologist was weighing in on an issue I needed her approval not for the end of the month but in the short term like 4 days. Frankly my wound care doctor simply did not rate an instant response.
This is the catch all area almost all doctors fall in this category, these doctors almost never talk to each other, they are experts in their field, and they are even really good doctors and nice people. They have opinions about care, and they are the final opinion about their type of care. This group includes the endocrinologist, nephrologist, neurologist, urologist, general surgeon, primary care doctor, ophthalmologist, rheumatologists, ER doctors, and the list goes on.
Here is the thing all these doctors are really good and of the most part they do our regular care. Thank goodness we do not need to go to area 1 doctor for much routine care. Still if these folks spot a problem they tend to get the blessing of the area 1 doctors before this move outside of routine care. I mean I suppose it is the way hierarchy of medical opinion, but my goodness. The other day my endocrinologist called my cardiologist to get her opinion on giving me tylenol for a headache. Now I know I am a complicated case, but really call the cardiologist, something is not completely thought out here.
Here is a second thing I learned recently. Area 2 doctors can become area 1 doctors, depending on their third party contacts. So I am in my cardiologist office and she wishes to run a test. Not a big deal, except she decides to call my neurologist for an over the telephone consult. Now let me state categorically I have never seen her call anyone for a consult while I was there. So why call the neurologist now? Well a big change happened. The neurologist was just added to the hospital board of directors and the medical review panel. So suddenly talking to her in particular is a good idea. I am lucky I have a neurologist who I think is great, got elevated. She is now in area 1. You have to love it when you hitch your wagon to a rising star.
Oh poor area 3 doctors. They toil at the bottom of the pole. Some examples of area 3 doctors are the podiatrist, dentist, optometrist, dermatologist and a few others. Now I really like these people. They are often off the beaten path, but I tend to see them a lot. But just for specialty stuff. They get little cross over and low and behold their opinions really do not matter much in the whole scheme of things. Ever go to your endocrinologist and tell them the dermatologist suggested some sort of treatment maybe a skin conditioner? It is like talking and no one is home. They really do not have time for such nonsense. Heck we are treating diabetes here, not some sort of dry skin. It is funny to have such a conversation. Oh and ask a podiatrist if they would do a telephone consult with a cardiologist, now that is a laugh a minute just to see the look on their face.
So what is the point? Not much really, I just think it is fun to watch doctors work. Once you see the hierarchy it becomes even more fun to watch them work. Now as someone who has a cardiologist and chest surgeon, I can assure you that part is not fun.