by Hannah Russell

Created on: May 19, 2010

Whenever a doctor is figuring out what is wrong with you, he or she is hardly ever just looking at the symptoms and the correct diagnosis pops into their head.  This would be one step short of voodoo. Doctors go through a long line of differential diagnoses that are each confirmed or refuted by different factors, lab results, test results, histories and situations.  Sometimes, doctors are operating under the assumption that one diagnosis is correct.  Then, a new symptom presents, new information is brought to the table and doctors are back to, maybe not square one, but perhaps square three.

Imagine you are in a hospital, being treated for hypertension.  At first, they think that your hypertension is related to an underlying vascular cause.  Some more information is brought in, and all the sudden, they decide that your hypertension is actually based in your kidneys.  It is not a case for the vascular doctor, it is for the nephrologist. Well, my friend, you are not lucky today.  You are in a vascular specialty hospital, the nearest nephrology hospital is across town, and consequently the nearest nephrologist is also across town.  The doctors cannot just run down to the next floor to talk to the nephrologist about it, they have to call them up and possibly bring the nephrologist across town to see you.  Sure, they can send them the results, talk to them on the phone, but something in physical features or some such subtle thing that is important to the nephrologist seemed completely and entirely irrelevant to the vascular specialist.  When the nephrologist gets there three hours later—there was traffic—the nephrologist informs your attending vascular doctors that this is not a nephrology problem at all.  Oh no, your hypertension is based in your endocrine system.  Not one of those hospitals until the next town over.  Fourteen hours later, you are released from the vascular hospital; the majority of your time was spent while your doctors conferred with other hospitals, and are ready to ride to the next town over for the endocrine hospital. Come now, you cannot tell me that this was not fun! All the same, you cannot help but wonder if what would happen if they just kept all these doctors inside the same hospital. 

Medicine is not an issue of one specialty.  Medicine is, and will always be, a multi-disciplinary science. Even when doctors know what the situation is, most care teams

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