The sun was out in full force in Seattle yesterday which is rare for late October. But there was little time to enjoy the blue skies and views (I get the most amazing view of Elliot Bay and the Olympic Mountains as I drive to work. The first dusting of snow was visible on the peaks). Instead, it was a busy day filled with a variety of medical activities starting with a visit to my rheumatologist.
It had been three months since the last visit. There was much to catch up on…the recent sinus infection (I’m supposed to stop taking Humira if the infection persists), check on the status of my fingers (they seem to be stable), carpal tunnel (the nightly use of wrist guards have that under control), and get an annual flu shot (I laughed at the puny size of the needle compared to Humira). Then there was issue with the Achilles tendons. Having been down this road before and having surgery on both sides, I can tell that they are tearing again. After much discussion about the situation, my rheumatologist stated,
“This is a complex situation and you should really see an orthopedic surgeon who specializes in feet and ankles.”
I spent much of the rest of the day trying to find such a specialist and set up an appointment.
This experience made me realize just how deep I’ve gotten into the world of the medical profession. I no longer see generalists like family docs and internists, but specialists who are focused on narrow areas of medicine. According the American Board of Medical Specialties,
“Medical specialty certification in the United States is a voluntary process. While medical licensure sets the minimum competency requirements to diagnose and treat patients, it is not specialty specific. Board certification—and the Gold Star—demonstrate a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” [i]
There are 24 boards running the gamut of many specialties. [ii] Rheumatologists are typically Board Certified in Internal Medicine first. Within internal medicine, there are 22 subspecialties including rheumatology. [iii] In order to be certified in rheumatology, the physician must complete the following requirements:
At the time of application, be previously certified in internal medicine
Satisfactorily complete the requisite graduate medical education fellowship training
Demonstrate clinical competence in the care of patients
My rheumatologist, in addition to being trained at a top notch university and medical school, holds board certification in internal medicine and rheumatology. He keeps current with ongoing training and reading the professional literature.
My search for an orthopedic surgeon with a subspecialty in feet and ankles was not easy. Most orthopedic surgeons focus on the more common areas like knees, shoulders, hips, and spines. After checking on several names given by my rheumatologist, looking at doctor reviews, and calling a few offices, I was getting a little frustrated. Fortunately, Seattle has the University of Washington Medical Center/Harborview Hospital – one of the premier centers in the country. At this center, there is the Foot and Ankle Institute . It was born primarily out of trauma treatments being developed in the 1960s. People would come in with smashed feet and ankles from accidents and the orthopedic surgeons began to develop wild, new procedures (like inserting screws into bones) which became the standard of care worldwide. In addition to being members of the American Board of Orthopedic Surgery [v] , the doctors of the Institute are also members of the American Orthopedic Foot & Ankle Society [vi] . My previous orthopedic surgeon (who I can no longer see due to changes in insurance) did his fellowship at this Institute. I decided that I didn’t want just anyone messing with my ankles the second time around, so I called and immediately made an appointment. While I can’t predict what the outcome will be (I’ll write future posts about it), I’m glad for the access to specialists who can treat my “special needs.”