Posted by Solstice on November 19, 2011, at 9:12:28
In reply to Re: psychopharmacologist vs psychaitrist » Solstice, posted by ed_uk2010 on November 19, 2011, at 7:39:03
> >I'm around neurologists all the time. The treatment of epilepsy here is highly specialized.
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> We do not have enough neurologists here to provide a satisfactory service to patients with complex needs. I don't know why it is this way. We have plenty of experts in other fields eg. cardiology.
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> >a GP or pediatrician will refer a patient to a neurologist for any condition that causes seizures.
>
> Here, paediatricians are hospital-based specialists. You cannot take your child straight to a paediatrician, you get referred by the GP. Our paediatricians treat a huge variety of acute and chronic diseases in children.Wow. Here, pediatricians are considered GP's for children. For the insured, everybody gets one for their kid - usually interviews them while pregnant. Pediatricians see kids in an office setting. They are often grouped together - there will be two or three of them share a suite of office in a clinic setting, and share nursing and other staff. Pediatricians will ensure the kids get their vaccinations, check growth, remove warts, take care of broken bones, ear infections, etc. But, for example, if the ear infections are repeated, the pediatrician will refer the kid out to an ENT (EarNoseThroat) specialist, who will do an exam and may recommend tubes (as was the case with one of my kids). Here, physicians - including specialists - have offices outside the hospital where they see patients, and have 'privileges' at one or more hospitals in the area. Most hospitals will have a 'professional building' adjacent to it where the doctors' offices are. The majority of them don't work 'for' the hospital (like the nurses and other medical staff do). They are more like contract labor. They bill the patients separately for their services. Your system has made it more efficient - whereas ours has encouraged too many cumbersome layers. Anyway, physicians don't usually work 'for' a hospital, they work 'at' a hospital - and usually they work at several hospitals.
I have juvenile, type 1 diabetes. I have seen the same endocrinologist since I was 21. When I got pregnant, my gynecologist transferred me to a 'high risk' obstetrician. She took care of everything except she relied on my endocrinologist to handle the diabetes. They communicated information regarding my care. My endocrinologist was an arrogant and irritating man, and at one point I told my obstetrician that I wanted to change endocrinologists - and I hoped she knew of a decent one. She literally begged me to not switch. She said "After the baby's born, you can switch - but please stay with him until then. I know he's annoying, but he really is the best we've got around here." After my baby was born, he became much less irritating because I didn't have to see him very much anymore :-) Then, when my child was about 18 months old, I got the flu and a couple of weeks later I was still not fully recovered. My mom was over for a visit, and it was Friday morning. I was still somewhat weak, but nothing dramatic. Mom insisted that I call my endocrinologist. To humor her, I did. I called his office, asked for him, and since he happened to be available, he got on the phone right away. I told him I was fine, my mom was just being a worry wort because it was taking me so long to get over the flu. He asked me what my blood sugar was. "140" I responded. He said "Well, even though it's not high, I can tell by the way you are breathing that you are in ketoacidosis. He told me to meet him at the hospital. Had his staff cancel the rest of the day's appointments, and he came over as soon as I arrived. He sat with me in the ER for about six hours, ordering blood gasses constantly. He later told me that I was very, very close to my breathing shutting down. He was annoying as heck having to put up with him nonstop (he wouldn't stop talking - I think he was trying to prevent me from falling asleep). And he kept yelling at nurses and otherwise just acting like a jerk. I was later put in ICU for a few days while my metabolism was put back in balance. He later told me that he'd once had another patient with a rare case of ketoacidosis with normal blood sugar. He had sent her to the ER and faxed instructions to the ER doctor. The ER doctor thought he'd made a mistake, and did the opposite (because ketoacidosis is usally accompanied by very high blood sugar). Anyway that patient died.. so that's why he didn't leave my side. Anyway - after he saved my life like that, I decided I could accommodate the jerk in him after all and we developed a rather warm and funny relationship. I still see him.
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> >For example, a GP might treat high blood pressure, but if the patient develops thyroid problems, they will probably see an endocrinologist, who will closely monitor treatment of their thyroid problem, and that treatment will be communicated to the GP.
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> I don't think we make much use of endocrinologists here. General physicians treat most common thyroid problems, especially hypothyroidism.Endocrinologists here treat the awfully common conditions of diabetes, thyroid issues, anything relating to glands that secrete hormones. Internists (who are more specialized GP's) will treat milder cases of diabetes - but once a patient starts having complications, they would be referred to an endocrinologist.
I'm fortunate in that after having Type 1 for nearly 30 years, I don't have a single complication.
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> >No doubt about it, specialists are highly used in this country.
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> I suppose it is good if you can afford it, but I do get the impression that your GPs may have become de-skilled. If patients see a different specialist for each part of their body, who co-ordinates their care?You're very right. Our GP's have become de-skilled in a way. Of course, the human body is so complex, maybe it's more that they are the first line of defense (flu, simple broken bones, stitches, vaccinations, etc.), and competently hand their patients off to specialists when more complex body systems are involved. GP's are the coordinators of care. The first thing any specialist asks, is "Who's your PCP?" (Primary care physician/GP). They want to know who to send their reports to. As for affording it, that's what insurance is for. If you don't have insurance, you're definitely screwed here as far as health care.
Solstice
poster:Solstice
thread:1002759
URL: http://www.dr-bob.org/babble/20111110/msgs/1003067.html