As I see it, one of the biggest problems we have is that the system is far too specialized. Everyone is responsible for one piece of the system and has no responsibility or incentive to connect properly to other parts of the system. My mother has ten different specialist doctors such as an oncologist, a pulmonologist, an opthalmologist, an orthopeadist, a cardiologist, etc. They only get measured on how they perform their part. No one individual knows what is happening with a patient overall and can make global holistic decisions. The fantasy that HMOs have pushed that the family doctor would do this hasn't happened. Those doctors have no time since they are being paid for volume instead of quality. As a result, it is left up to the individual or family members who also have their own lives and medical conditions with which to deal. The current reform in health care does not deal with this.

I think we should have a new type of doctor specialty - patient management. This doctor does not see patients directly, but deals with patients as a whole. This doctor manages a patient's complete medical care. All medical decisions by any one else (except in emergencies) must be discussed with the patient's case manager. That is all this doctor does. The patient would still have a family doctor and specialists who see the patient face to face, but the patient manager would see the global picture. The patient manager would be available to patients and providers via phone, e-mail, etc. The patient manager would recognize when a patient needs a treatment that other doctors who are too specialized aren't seeing.

This person would also manage the patient's records. When my mother was in the ER she did not have her medications nor access to her prescriptions and as a result, her blood pressure skyrocketed and she was denied care until it was returned to a more normal state. If she had a case manager, this could have been fixed with a few phone calls in a few minutes. The patient manager would have been involved from the beginning.

Because the patient manager would be a doctor, that person could work with doctors to make proper treatment decisions. Doctors would more likely accept the doctor patient manager as part of the decision making process. Currently insurance companies and hospitals have case managers, but they are not usually doctors and their focus is to keep the insurance company or hospital from being sued or spending too much money.

Hospitals have started hiring hospitalists who do what I am describing here because this is an ongoing problem. Hospitalists are doctors. However, they work for a hospital and only manage patients while in that hospital. We need someone dedicated to the patient in an out of the hospital.