Field of Vision

I’m a birder, a.k.a. bird watcher, and in choosing the best optics for a given situation one of the primary variables is field of vision. In general the higher the power of magnification, the smaller the field of vision. This is optimal for looking for motion, silhouettes and is the usual way to find birds. Using binoculars at 7-10x the magnification allows much more detail to be examined, but has a field of vision wide enough to easily find a bird first seen naked-eye. Then to see even more magnification detail I may choose to use a spotting scope. This is a tripod stabilized monocular telescope that has a much higher 20-60x magnification, but its narrow field of vision makes it less than useful unless a bird is sitting still allowing me to point the scope at the bird and look until I find it, or for scanning very distant locations.

As a family doctor I feel like one of the biggest advantages I have over my limited specialty colleagues is that I see patients with a wide angle focus, whereas often they see their patients through the high magnification narrow field-of-vision lens that is their specialty. Both types of focus are very important.

This thought came into mind today at a slow morning at our Same-Day Clinic while I was chatting with one of our physician assistants. She has asthma and last winter needed a shoulder imaging study. She has asthma, and the radiologist asked her to stop her asthma meds for a week to avoid possible drug interactions between her asthma meds and the contrast material she used for the imaging study. This led to an exacerbation in her asthma, complication pneumonia, and several months of major respiratory difficulty.

Maybe she really needed the study and this was unavoidable. More likely alternative asthma management or alternative imaging techniques could have avoided this scenario. The problem in part was the narrow focus of the involved radiologist.

I see this type of thing pretty often. My advice to patients it to find and keep a primary care doctor that you use for as much of your health care as is realistically possible. By having a primary physician you get the advantage of someone who has the wide-focus lens looking at the whole of your health concerns. This is not to say that you should not use specialist care. The skill set and mind set of delving deeply into a specific body-system and its pathology are needed in many situations. A rheumatologist may be extremely important in managing rheumatoid arthritis, or a neurologist in managing a difficult seizure disorder, multiple sclerosis or Parkinson’s disease. These advantages of subspecialty expertise and focus are often critical.

Having a primary physician who knows you well and sees you through a wider field of vision than the highly focused sub-specialist who may be needed for one or more of your conditions gives you someone looking at you with the naked-eye viewpoint. If I went birding looking only through my binoculars or spotting scope I’d get great looks at a few birds, but would miss most of the birds in the area. Depending on specialist for overall health care management may give you fine care of the parts of you that are seen, but may not see other issues and may not optimally put the specialty issues in the perspective of your whole self.

Your primary physician can keep an eye on you and use his binoculars or spotting scope to look into various concerns with more focus to see details, but may ask specialist to use their higher powered lenses to see in more detail issues best noted and put in perspective through the primary care physician’s optics.