The Great Deception..a prelude to the Vagina Monologues
So what was I really getting at with my last entry? That allergists really love carbureters? Or maybe something deeper? Let's admit it: as allergists we have deeply fallen in love with the respiratory tract. Yep. hook, line and sinker. Everything about it. We've got a shameless crush on the respiratory system. Just looking at the squiggles of a pulmonary function test sets our little hearts a-twitter (more than any carbureter would.) And, like any infatuation, our beloved (respiratory tract) is ALL we can think about, ALL the time...Now, superficially speaking, there is nothing wrong with that. Up to a point...
But--first and foremost--we're allergists--not "just asthma doctors"--, and we should really be interested in all target organs--skin, GI, nervous sytem--affected by abberations in immune system response. "Oh, but we are interested!" , you may insist. And, perhaps you're right--again, up to a point. But those of you who are attending meetings, reading allergy journals, and talking to other allergist colleagues--those of you who can face the truth honestly--will have to admit that 90% of our interest is in the respiratory tract. Oh, we give some attention to these "other" areas of allergy, but in my opinion, the kind of attention we really give them can be summed up in two words:
lip service.
Now I know at this point you're really mad at me: for I appear to be attacking our "Golden Calf"--the respiratory tract we so idolize and worship. But let me make another point, put another way: does the infectious disease specialist get "hung up" on one body organ, to the exclusion of any other? But nooooooo you say. True. And why is that? Because infectious disease involves the study of how infections affect all parts of the body. And so it should be with allergists.
And this, in my opinion, is "The Great Deception" perpretrated in our Allergy profession upon our patient population at large--that you must only wheeze, sneeze, or cough in order to see an allergist. And we encourage it. Face it: we mainly want to see asthma patients, perform a few perfunctory prick tests, give them the inhaler du jour, and send them back to their primary care physicians. No bowel problems to be discussed, if you please. (never mind that we've got 200 square meters of immunologically reactive organ surface there...) No chronic headaches, if you please. And certainly no hyperactivity/attention deficit disorders, please! For example, we tend to "leave" the chronic eczema and urticaria issues to the dermatologist. As an organization we don't aggressively fight for the "right" to examine these patients--we don't "market" ourselves to treat these illnesses nearly to the extent we market ourselves to treat asthma and allergic rhinitis. As one allergist told one of my colleagues, "when a patient with chronic urticaria comes in the front door, I run out the back door..." We have gradually allowed a body-system "atrophy" to occur in our profession. We have gone from being body-wide masters of allergic response, to only wanting to give our patients colorful inhalers to sniff and inhale. In our parent organizations, we have even tried to "piss on the tree" and "mark" our "territory" as asthma--by adding it to our organizations name. In short, we have over-emphasized respiratory allergy, to the near exclusion of everything other system-allergic response. Plese note: Emphasis is ok. Overemphasis is not. I get the distinct feeling that to the routine allergist, a patient is perceived as a set of sinuses and lungs with a life support system attached. And that, Jack, is completely unacceptable, and something that needs to be changed if we are to prosper as a profession...
Now I realize my comments may be perceived by some of you as putting me in the category of a Don Imus Allergist. (i.e., one who makes outrageous statements about the allergy field that are completely uncalled for). That's ok. My message: deal with it. Move on. We need to stop The Great Deception, and our marketing charade that overemphasizes asthma--not allergy. We need to reclaim our original calling...as allergists and masters of immune system aberrations throughout the body, and not just the airways. And in my next entry, I'll give one simple example of an area we have shamelessly ignored, to the detriment of our practices and our patients. So stay tuned...
Posted on Thursday, May 10, 2007 at 09:34PM
by
George F Kroker MD FACAAI
in Being a Superior Allergist
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George F Kroker MD FACAAI
in Being a Superior Allergist
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