{"id":30252,"date":"2022-06-06T13:27:11","date_gmt":"2022-06-06T18:27:11","guid":{"rendered":"https:\/\/wholehealthchicago.com\/blog\/?p=30252"},"modified":"2022-11-14T13:48:07","modified_gmt":"2022-11-14T19:48:07","slug":"longevity-medicine-how-your-herd-of-specialists-and-their-fragmented-care-can-shorten-your-life","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2022\/06\/06\/longevity-medicine-how-your-herd-of-specialists-and-their-fragmented-care-can-shorten-your-life","title":{"rendered":"Longevity Medicine: How Your Herd Of Specialists And Their Fragmented Care Can Shorten Your Life"},"content":{"rendered":"\n

\u201cSilo medicine\u201d. It\u2019s an odd way to express it, \u201csilo medicine\u201d, but there have been articles written using just this phrase to express one of the most serious flaws in the health care system.<\/p>\n\n\n\n

Picture an open field somewhere in the Midwest with a couple of dozen silos. \u201cCardiology\u201d, \u201cRheumatology\u201d, \u201cGeneral Surgery\u201d, \u201cPsychiatry\u201d, and so forth, painted across each silo, maybe adding the logo of the hospital system, Northwestern, U. of C., Loyola. Each specialty gets its own Silo, some much larger than others. Each Silo is the Center for the hundreds of doctors in that specialty. Lined up outside waiting to get in, sometimes weeks or months, is \u201cyou\u201d with your \u201cmysterious symptom\u201d.<\/p>\n\n\n\n

Your appointment to the Silo had been based on a quick evaluation at an emergency room or urgent care visit owned by the same (not for profit!) company that owns the Silo. Maybe you\u2019d been sent there by someone reasonably skilled at diagnosis, like your primary care doctor (PCP), likely on the payroll of the Silo company as well. It\u2019s certainly possible your PCP didn\u2019t think you needed a \u201csilo-specialist\u201d but felt pressure from you for the referral. In fact, admit it, this may be your second or third Silo company altogether. \u201cI\u2019ve been to Loyola, I\u2019ve been to U. of C., now I\u2019m going to try the biggest Silos of them all, Rochester, Minnesota and the Mayo Clinic!\u201d<\/p>\n\n\n\n

Once within the hallowed silo you\u2019ll be whacked about like the silver ball in a pinball game. Each time you\u2019re hit by the flipper and bang against a bumper, it lights up and you\u2019ll find yourself attached to a machine that hums and whirs. You may get nervous but don\u2019t worry, you\u2019ll be glanced over by nurses, students, and maybe even an actual physician. They\u2019ll know virtually nothing about you as a person or anything else about your health and well-being. Once your test is over, they\u2019ll never know anything about you again. \u201cProcedures\u201d, whether for biopsies, repairs, scoping, are always encouraged by physicians. Since the system is seriously inefficient, days and weeks go by between flipper \u201chits\u201d and bumper \u2018\u201dbumps\u201d. \u201cWe need to follow up on that abnormality on your mammogram with an ultrasound, but we\u2019re booked up eight weeks.\u201d You ask for some Klonopin to sleep, but this is refused to prevent you from becoming a drug addict.<\/p>\n\n\n\n

By the time you\u2019ve exhausted all that Silo #1 has to offer, and you\u2019re bordering on PTSD from the health care system, they admit they couldn\u2019t find anything except one tiny abnormal blood test which needs a follow up by a doctor at Silo #2, and the whole process starts all over again. Although Silo #1 records are available, you notice that the Silo #2 doctor doesn\u2019t even glance at them but does suggest a biopsy. Also, since your blood pressure is \u201ca bit high\u201d you need to see a \u201chypertension specialist\u201d in Silo #7 who happens to be on maternity leave.<\/p>\n\n\n\n

In her recent book, \u201cThe Invisible Kingdom: Reimagining Chronic Illness\u201d, Meghan O\u2019Rourke describes the helplessness of having a chronic illness and being shuttled from silo to silo with perpetually \u201cnegative\u201d tests. She had an almost physical longing for someone to just tie everything together and be in charge of the pieces of her care.<\/p>\n\n\n\n

This very same topic has been taken up by primary care doctors themselves. The most detailed paper, \u201cThe Problem of Fragmentation and the Need for Integrative<\/a> Solutions<\/a>\u201d, by Kurt Stange, M.D., addresses cases exactly like Ms. O\u2019Rourke\u2019s, but adds comments about overutilization and duplication of services, incredible cost overruns, and poor health outcomes. The U.S. ranks 37th<\/sup> in quality in regard to health care, and this is not necessarily lack of access but rather too much of the wrong kind.<\/p>\n\n\n\n

There are several takeaways from this somewhat cheerless Health Tip:<\/p>\n\n\n\n