ADVISING THE ADVISORS: THE NEED FOR SPECIALISTS

ADVISING THE ADVISORS: THE NEED FOR SPECIALISTS

ADVISING THE ADVISORS:
THE NEED FOR SPECIALISTS

by Peter J. Nebergall,
Ph.D.

When we're sick, when we perceive there
is something wrong with our bodies, we head for the doctor. We assume, we have
to assume, he/she "knows what is good for us." We want to get well,
and we're ready to "do as the doctor ordered."

In the past, we saw the "General Practitioner," and

today, in the day of the HMO, many of us see a similar

"Primary Care Provider," who we expect to either have the

answers, or send us on to someone who does.

The human body is enormously complex.
Medicine is not like math; even the basic principles routinely fall to new research.
Especially in diabetes research, the pace of change has been tremendous. To
expect one individual, however well trained, to have all the answers, to be
"up" on the latest research findings on our problem, is unrealistic--but
too many folks, both patients and doctors, give medical pronouncements the status
of Holy Writ.

Consider all the different things a General

Practitioner has to learn. Now consider, once a few years

out of medical school, keeping "doctor's hours," how much

time doctors have to keep their knowledge current,

especially of conditions they see infrequently, such as

ramifications of diabetes.

Those who think they know the answer are unlikely to

further pursue the question. If a given treatment was the

rule in 1975, when Dr. X completed his internship, and he

hasn't had occasion to think about it since, given the

demands on his time, is it any surprise he orders that

treatment in 1997, even though the latest research indicates

otherwise? He's the doctor.

So what's the answer? I am calling for a different way

of looking at the medical profession, both by patients and

by doctors themselves. To expect the single generalist to

"have it all," to be the ultimate unimpeachable authority,

in this age of explosive change and exponentially increased

information availability, is unrealistic, even unfair. We

should not expect it of our doctors, and they should not

expect it of themselves. There is too much to learn; far

too much for one mind, however brilliant, to fully

assimilate. We already have our medical specialists; our

problem lies with their gatekeepers, the generalists who

control our access to them.

Most primary care doctors are careful
and conscientious, but the rest of us, the consumers of their product, have
placed them on a high pedestal. We ask more of our primary physicians than they
can possibly deliver--and it takes a strong, well balanced doctor to admit his/her
limitations and say: "No, I don't have the answer, I have to send you on
to someone who does." It's very easy, especially with HMO directors watching
the bottom line, to instead reach for a treatment modality that was current
20 years ago...

ALL OF US need to accept our doctors' limitations.

They dispense knowledge and good judgement, not gospel. In

many cases, that is sufficient; but where it is not, sending

the patient on to the diabetologist, the nephrologist, or

the endocrinologist, can be a matter of life and death.

There is a role for the diabetes specialist, just as there

is a role for the dietitian and the diabetes educator. Our

primary physicians need to stop seeing their/our need for

specialist assistance as a personal defeat. We're all on

the same side.