Medical Specialization Can Lead to Poor Results

When doctors see only one part of a patient’s problem, bad things can happen

The trend of increasing specialization in medicine has produced improved health care for many. However, it also may lead to adverse and unintended consequences. There is an old saying, “We see what we recognize and we recognize what we know.” My wife’s recent eye care is a case in point. I offer it up as a cautionary tale.

The cornea is part of the outer layer of the eye. If the cornea becomes diseased or cloudy vision is affected. It is kind of like trying to see through a dirty car windshield. She was born with Granular Corneal Dystrophy (GCD). We would later learn that this autosomal dominant gene was thought to have originated in a small Southern Italian City of Avellino, just east of Naples. Since her grandmother was born not too far away, the epidemiology and genetics made sense. There are many types of corneal dystrophies. They are characterized by deposits in certain layers of the cornea and do not usually affect vision until the fifth or sixth decade of life. Her uncle and her mother both had corneal transplants. The best treatment to improve her vision is corneal transplantation — either full or partial. This is not without risks. Since my wife was an art teacher, loss of vision added to her decision to retire at age 65.

Shortly before retirement, her ophthalmologist, Dr. B, diagnosed her with cataracts and said they should be removed before addressing her corneal disease. The cataracts had been getting worse and so they…