Continuity of care

I saw a patient whom I had seen 2 years ago. At that time, I told her it was either one of two things. I gave her some scripts and told her to follow up with her primary care doctor for further workup. After 2 years, she came back with the exact same problem, but in the intervening two years, she has seen 4 internists, 3 urgent cares, 2 ER visits, and 2 specialists all for the same problem, and never her primary care doc. I was foolish enough to order records, and I wanted to cry. Every assessment is the same: this is either diagnoses A or diagnosis B. Follow up with PCP.

I had another patient a while back who was on her 6th internist in 6 years. Every internist and every specialist told her the same thing every time, but she only saw each doctor once. Which is no surprise whatsoever. Because we all saw the same things.

Some people think that the more doctors you see, the better. This is, by and large, false. As doctors, we're trained to think of common things first, and so when presented with a certain set of symptoms and findings, we look for the common disease. If you took a room full of doctors and gave us all a set of symptoms, 80% of us will come up with the same diagnosis, regardless of experience or training. Because we find the common one first.

It's like only being able to read the first page of a book. There may be so much more there, but if all you have is one page, what can you possibly know?