Challenges of Sharing Patient Care

There are some disorders endocrinologists treat that we “share” with other subspecialties. Sometimes, it can be difficult to determine who is ultimately responsible for treating a patient.

Let’s take osteoporosis for example. It can be treated by endocrinologists, but is often also treated by rheumatologists, gynecologists, primary care physicians, and orthopedists (although orthopedists usually limit themselves to fracture treatment only). So I have some patients I see for diabetes, for example, who see a rheumatologist for their arthritis and go to the gynecologist for their annual pap smear and exam and their primary care doctor for their annual physical and for general medical care. If I know that one of their other physicians is managing the osteoporosis, I leave that to them. But sometimes, one of their other doctors will order a DXA, but then tell the patient to call me for treatment.  Well, ok, I can manage that, but then when I tell the patient what tests to have and when, they say “Oh, well Dr. Smith wants me to do X, Y, Z”. That makes it confusing for the patient and the physician.

Another shared disorder is hyperlipidemia. Endocrinologists and cardiologists both treat it, and there are some who take a special interest in it. And I have no qualms about sending patients I am having difficulty managing to someone who deems himself a lipid specialist. Apparently, not everyone agrees with me. I have a patient with very severe hypertriglyceridemia. He is on everything I know to put him on. His triglycerides are still extremely high. I sent him to a local cardiologist who has a particular interest in lipid disorders. I told the patient that I am not sending him there for his heart disease, he is already seeing a cardiologist, I am strictly sending him there for his lipids. Well, his usual cardiologist got wind of this and, suffice it to say, he was not happy with me. I felt that I was the one who was primarily managing his lipid disorder and that it was in the patient’s best interest to see someone who may be able to help him further.

I am sure other specialties have the same issue – hypertension shares by nephro and cardio, for example. 

Yes, healthcare should be a team effort, but to keep things running smoothly, and to avoid patient confusion (oh, who should I listen to?) sometimes we need to be assigned our specific roles in a patient’s care.