Professional Silos

I grew up in a small town in southern Saskatchewan. We had a couple of doctors and a small hospital, but we rarely had contact with “specialists” and, if necessary, we needed to drive almost an hour to the nearest town for evaluation and treatment.

Doctors made house calls back then and took care of all our physical and mental illnesses with only the help of instruments carried in a black bag.

Things are VERY different today. It is unusual to think that a doctor can make a house call and those in the medical profession have a limited scope of practice that clearly defines what they will and will not do. That might not include what we think they should do or what we need.

I recently enjoyed the book “The Checklist Manifesto” by Atul Gawande, a medical doctor who argues that we now have not only specialists but also super specialists. For example, in the past we might have thought that we just needed to find a surgeon to operate on our knee. Now we need to make sure we find a surgeon who really specializes in knee surgery.

This became very real to me last year when my daughter-in-law had a golf ball-sized growth on her lung. She lives in Saskatoon, where there are several large hospitals, but was told there was only one specialist in Western Canada who could perform the operation. She was in Calgary!

When it comes to mental health, we face the same complexities. There are psychiatrists who specialize in thought and mood disorders. They can prescribe and hospitalize, but appointments are often difficult to get and of short duration. In Alberta, they are covered by provincial funding, so there is no charge for their “patients.”

Psychologists cannot prescribe or hospitalize and have different specializations. Some focus on children, or adults, couples, companies or groups. Their practices may offer clinical (mental illness), educational, research, or counseling services. Some do evaluation while others provide therapy.

Those who describe themselves as therapists or counselors tend to have less training than psychiatrists or psychologists and tend to work in specific areas such as addictions, parenting or professional issues.

And then there are family doctors who, due to lack of time and long waiting lists, frequently refer those with special needs to other professionals.

Our system has moved far away from the one rural doctor who takes care of everything. Now we are faced with trying to understand professional silos. Dividing our healthcare system into specialized practice areas often means confusion for the general public. Where are you going? How can you get help?

The secret to finding someone who can deal with a problem is threefold:

1. Know what you need and want from a service. Is it suicide prevention, assessment for vocational training, depression treatment, or just someone who can listen?
2. Do some research. Most professionals have a website or intake system that allows you to ask good questions. Find out if there is a charge for sessions. Do you need to do paperwork before the first date? What types of services are offered?
3. Be ready and willing to set goals and work to achieve them.

There are no magic solutions and change requires your time and energy. There is no professional who can solve your problems, but if you are committed to change and prepared to make the effort, I know that progress will be made.