Who is the bone doctor? Who should I go to: the traumatologist or the rheumatologist?

Rheumatology It is one of the youngest specialties of internal medicine, it originated in 1949, when Hollander, when using the expression rheumatology in his book “Arthritis and Associated Diseases”, resulted in the birth of the specialty as such. In our country, the appearance of the rheumatology specialty was still, if possible, a little later, since it barely has more than half a century of life and in the beginning it was constituted, exclusively, as a strictly hospital specialty , since the well-known figure of rheumatologist area specialist, located in the ambulatory specialty center, was consolidated a few years later.

This delay in time and the excessive delay in the appearance of the specialty in our country explains and justifies, to some extent, the general ignorance and to some extent, the tremendous confusion and disorientation, which exists so widespread among the general population, about what is the real object and purpose of the rheumatology specialty, as well as what are the main functions that the rheumatologist actually performs. Amid the enormous confusion that exists about rheumatism, all kinds of hoaxes, neighborhood councils, healing foods, magical gadgets and a long list about the possible causes of these ailments have flourished around him. There is hardly anyone profane who has no free theory regarding rheumatism, or who does not feel he possesses any remedy or therapeutic inspiration for such an issue, and we can often hear, how the question that is most asked in the street regarding a joint pain is: Hey, it hurts here, where am I going, to the “physio”, to my family doctor, to the traumatologist? But few, although increasingly, have the illumination or knowledge necessary to affirm: to the rheumatologist, head.

And it is that many people still continue today, convinced that the medical specialist of the musculoskeletal system, which they know as the “bone doctor”Who really has to treat them, is none other than the specialist in traumatology and orthopedics.

This error has most likely been generated and even encouraged, in part at least, by our own healthcare system, since for a long time, the figure of the traumatologist was established, as the first step of access of the rheumatic patient, to the specialist. In fact, traditionally and until the recognition of rheumatology as an autonomous and established medical specialty took place, the care and subsequent treatment of the musculoskeletal patients in our country, the health authorities had always deposited in surgical hands of traumatologists and orthopedic surgeons. And this, despite the fact that as a general rule, in a vast majority of cases, rheumatic patients were never going to have the need to perform any surgical therapy.

The rheumatologist, because of his training and experience, is the specialist best prepared to correctly carry out the process of diagnosis and medical treatment of the pathology of the musculoskeletal system. Since conservative treatment, it will surely be the only one necessary to solve and / or control most of these pathologies. In those cases in which it is necessary to carry out, afterwards, some treatment of a surgical nature, then the rheumatologist will refer the patient to the consultation of the traumatologist, who will be responsible for carrying out said surgical treatment, which is what It has been prepared during its formative period. This is the distribution that has been demonstrated more logical, coordinated and efficient, for the correct treatment of all the nontraumatic pathology of the musculoskeletal system.

However, currently in the general population the erroneous impression that The specialist doctor in charge of treating bone diseases should be the traumatologist.

Thus, it is certainly common that when the patient arrives, for the first time, at our rheumatology office, he manifests frequent feelings of strangeness and confusion at the beginning, and even experiences a certain disorientation, in relation to the reason for the consultation. And therefore, it is quite frequent that, before entering the subject itself, they begin their somewhat timid stories, indirectly excusing themselves through the frequent use of expressions and circumlocutions such as “I don't know if I went to the right consultation? or” I don't know if I come to the right specialist “or “I don't know well, if this happens to me, it is up to the rheumatologist” or “I don't know if this is something of your competence” or finally “I don't know if what is happening to me is of his specialty”.

No one who presents a persistent process of cough and respiratory fatigue Addresses the consultation of the thoracic surgery specialist, but rather he goes to the pulmonologist's office in the first instance, to know the cause and extent of his respiratory problem. Nor is anyone who has been suffering frequently, in their daily lives, from habitual headache or frequent and persistent headache and intends to find out at once the nature of the problem, is directed to the consultation of the specialist in neurosurgery, but usually requests, at the beginning, consultation with the specialist in neurology.

Well, in this way, with this logical, sequential and chronological order, the flow of patients in most medical specialties works and coordinates properly. In the first instance, the specialist doctor acts clinical and later and only in the event that your contest is really necessary, in a second instance would the specialist doctor then take action surgical correspondent.

We believe that this form of elementary interdisciplinary collaboration, thus established and in force, which seems to us all to be so suitable and perfectly adequate, is undoubtedly the best way to act, since it certainly has a very positive impact, for the clear benefit of each and every one of the different agents of the health system, which are thus involved in the proper management and proper performance of the pathology of the musculoskeletal system.

First, it will benefit the rheumatologist, because being the best trained specialist to perform the diagnosis and treatment of the medical pathology of the musculoskeletal system, without a doubt, the most frequent and numerous, the one that will not require any surgical treatment for its resolution, will become the main actor, more suitable and suitable, to bring this process to fruition.

Secondly, it will have a very striking impact on the benefit of traumatologist, because mostly he will be able to be thus freed from this clinical work and therefore he will be able to devote his time, now more free, in a very preferential way, to doing what he has been specifically training for and that without a doubt, He better knows what to do and that it is nothing other than the difficult and complicated surgery of the musculoskeletal system.

And finally, last and not least, it will benefit the patient above all. Because at all times of the evolutionary process of his illness, whatever it may be, the patient will always be conveniently treated and treated by the most appropriate specialist for him, at that specific moment, whether clinical or surgical.

In our country, and specifically in what refers to the pathology of the musculoskeletal system, this form of action, apparently as logical and correct as the one we have described, has not been fully installed yet.a, in the mentality of the general population, we could say, that currently it is not yet fully assimilated by society. And this is undoubtedly due to the fact that they are still very strongly rooted, in the collective subconscious, old apprehended automatisms, as well as ancient inherited inertia, that for a long time they have remained so imposed and established and that in all likelihood it will take a long time to get rid of them completely and, therefore, take them for granted once and for all.

In conclusion, it should be clear that, for the patient of the musculoskeletal system, it is going to be considerably more beneficial to start his diagnostic pilgrimage through the rheumatology office, since the process will finally be, surely, tighter in time, probably much reduced in costs and, of course, always better for the interests of the patient, regardless of where the pilgrimage will conclude. Therefore, do not hesitate and Put a rheumatologist in your life!Surely it will do better.

We are convinced that in the future, with some perseverance, the adequate constancy, the necessary patience and, of course, that of every essential point, information of our population, little by little, will have to overcome all these obstacles and overcome all these difficult barriers, which will eventually disappear.