The specialists: Treatment as a team effort

Web posted December 30, 1998

By Korky Vann
Special to The Hartford Courant

Remember ``Marcus Welby, M.D.,'' the warm and caring television doctor who knew all his patients by name, diagnosed and treated their illnesses, dispensed advice and even made house calls? If you do, you're probably old enough to also remember when having a single, trusted family doctor was a reality, not a made-for-TV fantasy.

Now medical treatment is a team effort that includes specialists, nurses, technicians, therapists, aides, assistants and other professionals. Figuring out who's who in today's health care can be a real challenge.

``Having that `best friend,' lifelong family doctor is a thing of the past,'' says Dr. Alan N. Schwartz, author of ``Getting the Best From Your Doctor, An Insider's Guide to the Health Care You Deserve'' (Chronimed Publishing, 1998). ``More often, people find themselves in a system of managed care, being treated by a wide range of providers.''

Schwartz says good communication is the key to good care, whether you're talking to medical specialists, your primary care physician or any medical person.

``If you don't understand what you're being treated for or by whom, ask,'' says Schwartz, ``and don't proceed until you're clear and satisfied with the answers.''

To help, Schwartz includes in his book a glossary of providers and the treatments they offer.

``Starting with the basics, internists specialize in the diagnosis and medical treatment of diseases in adults. (Internists are) who most people see as their primary care physician,'' says Schwartz. ``Your internist then refers you to specialists as needed.''

The National Institute on Aging says specialists frequently seen by older adults include:

Ophthalmologists -- specialists in eye care who treat disorders including cataracts and glaucoma.

Urologists -- specialists in the urinary system in both sexes and in the male reproductive system.

Endocrinologists -- Specialists in glandular/hormonal disorders, including diabetes and thyroid problems.

Cardiologists -- specialists who diagnose and treat problems of the heart and circulatory system.

Gastroenterologists -- specialists in diseases of the digestive tract.

Rheumatologists -- specialists in arthritis and rheumatism.

Pulmonary specialist -- A physician who treats disorders of the lungs and chest.

Oncologists -- specialists in the treatment of cancer.

Hematologists -- specialists in blood disorders.

Gayle Kataja, regional director for Connecticut Community Care, says understanding who's who in nursing, rehabilitative and general medical care is also important.

``The `alphabet soup' medical jargon of today is overwhelming, and medical folk sometimes forget not everyone knows what it all means,'' says Kataja. ``We have `APRNs,' `PAs,' `PTs,' `OTs' and more. It can be very confusing.''

An APRN, or advanced practice registered nurse, is a registered nurse with training beyond basic nursing education. With physician backup, APRNs perform physical exams and diagnostic tests and in some cases, prescribe medicines. Kataja says many nursing homes are contracting with APRNs to provide on-site care for patients.

Physician Assistants, or PAs, usually work in hospitals or a doctor's office, under the supervision of a physician. PAs perform such tasks as taking medical histories and doing examinations.

Other nursing care providers include Licensed Practical Nurses, or LPNs, certified nurses aides and home health aides, who all provide routine patient care in hospitals, nursing homes and in patients' homes.

After surgery, a stroke or illness, individuals may need rehab or rehabilitation. Rehabilitative care providers include occupational therapists, or OTs, who help increase or restore daily living skills, physical therapists, or PTs, who help those whose strength, ability or sensation is impaired, and speech-language pathologists, who help with speech and language problems.