“Silo medicine”. It’s an odd way to express it, “silo medicine”, but there have been articles written using just this phrase to express one of the most serious flaws in the health care system.
Picture an open field somewhere in the Midwest with a couple of dozen silos. “Cardiology”, “Rheumatology”, “General Surgery”, “Psychiatry”, 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 “you” with your “mysterious symptom”.
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’d 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’s certainly possible your PCP didn’t think you needed a “silo-specialist” but felt pressure from you for the referral. In fact, admit it, this may be your second or third Silo company altogether. “I’ve been to Loyola, I’ve been to U. of C., now I’m going to try the biggest Silos of them all, Rochester, Minnesota and the Mayo Clinic!”
Once within the hallowed silo you’ll be whacked about like the silver ball in a pinball game. Each time you’re hit by the flipper and bang against a bumper, it lights up and you’ll find yourself attached to a machine that hums and whirs. You may get nervous but don’t worry, you’ll be glanced over by nurses, students, and maybe even an actual physician. They’ll know virtually nothing about you as a person or anything else about your health and well-being. Once your test is over, they’ll never know anything about you again. “Procedures”, whether for biopsies, repairs, scoping, are always encouraged by physicians. Since the system is seriously inefficient, days and weeks go by between flipper “hits” and bumper ‘”bumps”. “We need to follow up on that abnormality on your mammogram with an ultrasound, but we’re booked up eight weeks.” You ask for some Klonopin to sleep, but this is refused to prevent you from becoming a drug addict.
Why does this inefficient fragmentation of health care continue?
