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Ologist Care is Best

 

Pretty much all the GIMeC members believe ologist care is best. An ologist is a doctor whose title ends in -ologist (dermatologist, cardiologist, etc., and throw in the surgical fields as well).

To create a more equitable and affordable healthcare system, it’s important that everyone recognize the roles of the two major branches of physicians: generalists, or primary care physicians, and the ologists. Many people seem to have the mistaken belief that only the best doctors go on to limit their practice to one body part or a handful of procedures. There are better ways to look at the division of labor.

Primary care physicians, especially family physicians, are the best at making medical decisions with a strong dose of common sense. They don’t feel that every possible test or treatment has to be ordered at every visit. A lot of times a pat on the back of reassurance is the best medicine.

Family physicians are better than any other doctors at explaining diagnoses and treatment plans in language anyone can understand. Family physicians are more comfortable than any other doctors at taking the cost burden to a patient into consideration and handling complex situations. (For a more thorough discussion of the unique characteristics of family medicine, I refer you to the Future of Family Medicine Project from 2004. http://www.annfammed.org/cgi/content/full/2/suppl_1/s3/T3. I’ll warn you — the writing in this report gets a little fru-fru.)

For those of you old enough to remember the managed care era, ask yourself this: why did all those HMOs want family physicians to be the “gatekeepers” — a name I disliked the first time I heard it? It was because as far back as the 1980s there was evidence that family physicians provide better health at a lower cost than multi-specialty approaches to healthcare. I could go on and on about this topic, but I’ll stop here and refer interested readers to a comprehensive list of studies supporting this notion by the Robert Graham Center http://www.graham-center.org/online/graham/home/publications.theme.1.html.   Also, read anything by Barbara Starfield, MD.

Therefore, the proper division of labor between the two physician branches is that most of your healthcare concerns be treated by generalists. Ologists should only come into your life if they have a limited and defined role. Bouncing around from one body part doctor to another decreases the quality of your care and only serves to line the pockets of insurance companies.

2 Responses to Ologist Care is Best

  1. Lisa Thornton MD on October 10, 2010 at 9:48 pm

    While I agree with you that ologist care is best left to complicated medical conditions I differ with you that bouncing from body part to body part lines the pockets of insurance companies. In fact the opposite is true. Insurance companies work very hard to keep their members away from ologists by using “gatekeepers”. The more specialists a patient sees, the more dollars they expend and their insurance premiums generally do not rise in relation so these patients are the ones that acutally cost the insurance companies money, thus the dreaded (and soon to be illegal) pre-existing condition clause.

    • Richard Young MD on October 10, 2010 at 9:54 pm

      Dr. Thornton,

      Thanks for your thoughts.

      There are still a few HMOs in the country that enforce a gatekeeper approach, but they are few and far in between. The vast majority of privately-insured Americans are in PPOs or similar products that don’t restrict access to any doctors. Most insurance companies want nothing to do with cost-control, other than to provide mostly useless add-on products such as disease management companies and worksite wellness programs. That’s how they convince their corporate clients they are trying to reduce healthcare costs.

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