Article Text
PDF
Statistics from Altmetric.com
Introduction
There are centres of excellence in many fields of medicine across Europe, providing high-quality healthcare.1 2 In recent years, we have witnessed how the journey down the rabbit hole of specialisation may leave patients and physicians stranded on isolated ‘islands of specialisation’, sometimes irreparably distant from the mainland and other islands.
While these ‘islands’ give great advantage to people with complex and specific disorders, their isolation harbours some risks. For example, there may be ‘tunnel vision’ when interpreting all signs and symptoms within one’s strict framework of reference.3 Another problem is comorbidity, with many patients developing unrelated medical conditions over their lifespan, which may be missed unless a broader approach is used.
An important challenge in healthcare is to continue to profit from the unique expertise within each of these separate islands, while also building bridges to connect them. Here, we illustrate the value of establishing such solid bridges between islands of specialisation in healthcare for two patients referred to our medical centre.
Example 1
A 74-year-old man, a former professional violin player, was diagnosed with Parkinson’s disease at the age of 66 years. He was initially treated with medication and was stable. Several years after the diagnosis, he developed progressive difficulties moving his right arm. On examination, there were no signs of increasing bradykinesia or rigidity during dedicated motor tasks, but initially, a full neurological examination was not performed. His levodopa dose was slightly increased but to no avail. At follow-up, a more comprehensive neurological examination identified muscle weakness of the right wrist and finger extensors, which was felt to be incompatible with Parkinson’s disease. The possibility of a peripheral nerve disease was considered. The patient was referred to a neuromuscular expert (a second ‘island’), who …
Footnotes
X @rmmaraujo, @basbloem
Contributors RA provided significant contributions to early and later versions of the manuscript. SM and NvA were involved in the care of patient 2 and provided significant contributions to early versions of the manuscript. BRB was the neurologist in charge of the patient illustrated in example 1, provided an original concept and provided critical contributions and revisions to early and final versions of the manuscript.
Funding BRB was supported by a centre of excellence grant from the Parkinson’s Foundation.
Competing interests None of the authors have any conflict of interest report that is relevant to the present publication. Outside the present work, BRB has the following to report. He is co-editor in chief for the Journal of Parkinson’s Disease. He is on the editorial board of practical neurology and digital biomarkers; has received honoraria from being on the scientific advisory board for AbbVie, Biogen and UCB; has received fees for speaking at conferences from AbbVie, Zambon, Roche, GE Healthcare and Bial; and has received research support from the Netherlands Organization for Scientific Research, the Michael J Fox Foundation, UCB, Not Impossible, the Hersenstichting Nederland, the Parkinson’s Foundation, Verily Life Sciences, Horizon 2020 and the Parkinson Vereniging (all paid to the institute). NvA performs editorial services for Wiley Publishing Inc and is an ultrasound instructor for Sonoskills; all payments go to their employer. SM reports personal fees from Bayer, grants and personal fees from Pfizer, grants and personal fees from Boehringer-Ingelheim, personal fees from Portola/Alexion/AstraZeneca, personal fees from AbbVie, personal fees from BMS Pfizer, personal fees from Norgine, personal fees from Viatris and personal fees from Sanofi, outside the submitted work and all paid to her institution. RA reports speaking fees from Bial and Roche, outside the submitted work.
Provenance and peer review Not commissioned. Externally peer reviewed by Steven Lewis, Pennsylvania, USA.