Too much specialization?

One thing I have noticed on this neurology rotation and other rotations with specialists is that the attending physicians become hyper focused on their one area and often become blind to anything that falls out of their expertise. This would be fine if human illness was confined to given organ systems and never overlapped with other pathologies. Unfortunately nearly every illness impacts and is impacted by multiple systems within the body. I think in certain situations this type of focused care can lead to inability to diagnose and treat the real cause of a given illness. 

For example; today I was working with an extremely well versed neurologist. We had a 54 year old women with a history of gastric bypass in 2005 who was referred to us for unexplained episodes of a warm sensation starting in her gut and spreading throughout her body followed by shortness of breath, hyperventilation, and tingling. During the episodes she has to sit down and try to relax until it passes which usually takes 10 to 15 minutes. The neurologist grilled us on all the possible neurological causes. He went over every possible nerve involved and thought about it for quite some time. Never once did he even hint at the possibility that this may be something caused by something other than a neurologic pathology.

The patient seemed very anxious too and had a history of depression and just seemed like the type of patient to me that is constantly anxious. Immediately I thought that these episodes sounded like panic attacks. I also considered possible GI issues. These seemed more likely to me than a neurologic syndrome. This particular neurologist is not the type who wants to be second guessed. So I kept my mouth shut and just hoped he would come to a similiar conclusion but he never did. Ultimately the patient was told "we do not know why this is happening". She was told to try to see is anything provoked the episodes and to see if anything made the episodes better. I think many of these specialists have focused their work and studies so sharply that they are often blinded and miss a very simple diagnosis because they make it too complicated. Later in the day I asked the neurologist about this patient and I said "is there anyway this could have been a panic attack?" He responded with "you know, I never even thought of that...."

It would have been very easy to have the patient try a benzodiazepine at the onset of the next episode and see if that helped ease or end the episode. Also many different GI drugs and tests could have been used to rule out GI causes. Hopefully this patient will stumble into a GI specialists office or a psychiatrist or other doctor who recognizes panic attacks. I have seen many patients with specialists who have had there symptoms molded and manipulated until they fit awkwardly into an explanation within the specialist's field. I think this may be common. An excellent primary care doctor can prevent a lot of this by guiding the patient in the right direction or diagnosing the symptoms correctly before having to get a specialist involved.