Consultative Medicine

An Emerging Sub- Specialty for Patients with Complex Conditions

Linda N. Geng, M.D., Ph.D., Abraham Verghese, M.D., and Jon C. Tilburt, M.D.   NEJM Dec 23 2021

Patients with unusual, perplexing, or complex symptoms and conditions are not well served by
the fast-paced U.S. health care system.

An estimated 20 to 30% of all primary care consultations are for “medically unexplained symptoms” for which standard evaluations have resulted in no medical diagnosis.1,2

Although clinicians may be tempted to assume that psychological factors account for these symptoms, this large and heterogeneous group of patients also includes those with rare diseases, atypical presentations, new or unknown conditions, and complex illnesses
that challenge standard evaluation.

These patients have varied presentations and outcomes, but they often share a common experience: long, exasperating diagnostic journeys in which they bounce from specialist to specialist in an ultraspecialized health care system that rewards high throughput rather than individualized care.

In recent years, medical centers around the world have been exploring ways to help patients with puzzling ailments who fall through the cracks of established health care systems, reflecting the emergence of “consultative medicine” as a diagnostic specialty.

This emerging specialty, rooted in generalism, aims to integrate the best of the Oslerian diagnostic tradition with the multidisciplinary collaboration and modern technologies needed to tackle uncertain, difficult, or complex diagnoses.