Tuesday, October 13, 2009

Specialists vs. generalists

When you need to get your car fixed, you take it to a local garage or maybe the dealer for work. The local garage would be a little cheaper but there might be a convenience factor, closer to you, or maybe you know the people there. If you choose the other option, the dealer will probably charge you more but you feel that you are probably getting better quality work done. But what's the difference in the end? Your car is fixed. Your wallet might be a different size but that's about it. The local garage would be a generalist but the dealer would be a specialist.

Now comparing this to taking care of our bodies. We all see a bunch of specialists. The closest we come to to a general practitioner (generalist) these days is our Internal Medicine doctors - but aren't they really specialists these days? I have lots of doctors (internal medicine, radiation oncologist, medical oncologist, breast surgeon, pain clinic doctor, back surgeon and a bunch of others I don't see any more). The other day, The New York Times had a commentary on how women with breast cancer have to see many diverse practitioners and risk falling through the cracks. I agree with her point at the end that focus on finding the cure, should also include organizing the existing medical care.

I think I get good care at the local hospital where I see a bunch of specialists. I could go into Boston to Dana Farber, which is less than 10 miles by car. But I am comfortable where I am. I like going to the smaller hospital (which really isn't that small) and not dealing with city traffic - that 10 miles could be an hour at the wrong time of day. I can make it door to door in less than 15 minutes, closer to 10 if I hit all the lights. I can keep my notes together and bring them to each appointment and not feel like I am just a number. I think I am okay managing my own care but if anyone wanted to step in and take it over, I'd probably let them to an extent.

In the meantime, today I am working from home this morning. This means I will negotiate with the cat on how much of my lap he can have and how often he will get little pieces of chicken (right now lots because I just stepped on his tail by accident). I hope to get a walk in this morning but it is rainy and 47 tropical degrees. So it might be a cold/damp experience instead of a nice walk. Then I am off to work and to get a hair cut. (And I prompted my husband on this so he might notice when I come home...) Oh, and my back hurts.

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