care. Breaking this silo means specialists like me actively defending primary care’ s seat at the table, not just clinically, but in how Medicare and payers value the work. It means co-managing heart failure, diabetes and post-procedural care with primary care rather than treating referral as the end of our responsibility. It means using interoperable records so a primary care physician can see what happened in our tumor board or heart team meeting about the patient referred. And it means GLMS, in our advocacy work, we will continue to include our push for fair Medicare payment. We speak for the whole house of medicine, not just the specialties with the loudest procedural volume.
Dementia and Alzheimer’ s: The Case for Earlier, Not Later, Collaboration
Nowhere is the cost of delayed collaboration more quietly devastating than in cognitive decline. Primary care physicians are almost always the first to notice it: a missed medication refill, a spouse mentioning repeated questions, a patient who can no longer reconcile the checkbook. Too often, though, that early signal sits for months or years before a referral to neurology, neuropsychiatry or behavioral health is made, usually because the patient hasn’ t yet crossed some informal threshold of referral. That delay has a cost we can now measure. Earlier identification of mild cognitive impairment and early-stage Alzheimer’ s opens a window for disease-modifying therapies that work best before significant neuronal loss, and for safety planning before a driving accident or a financial exploitation event occurs. Behavioral health and neuropsychiatry colleagues can also begin addressing the depression, anxiety and agitation that frequently accompany early cognitive change, symptoms a primary care visit often doesn’ t have time to unpack fully, but which respond well to treatment when caught early.
The synergy is paramount. A primary care physician who flags a borderline cognitive screen should be able to get a neuropsychiatry or behavioral health colleague looped in within weeks, not months, with a colleague who should be able to see the primary care note, the medication list and prior screening trends without re-creating them from scratch. This is precisely where interoperable records matter most. Cognitive decline is best detected through a pattern that is only visible if the data exists from every visit: primary care, neurology, behavioral health. Early dementia and Alzheimer’ s recognition must translate into earlier intervention as we treat the referral pathway itself as part of the clinical infrastructure.
Synergy Requires Infrastructure, Not Just Goodwill
The next frontier is interoperability, where data systems that let a primary care physician, a cardiologist and a hospital’ s shock team all see the same patient record in real time, regardless of which institution generated it. Hospital systems have made real progress here, but we have farther to go before data moves as fluidly as our patients do, among them all. The infrastructure requires shared scheduling, shared documentation and shared accountability for outcomes.
United We Rise
This is, in the end, the same idea behind our presidential theme this year: united we rise, in voice and purpose. Our job, individually and as a medical society, is to build the structures – clinical, financial and informational – that let expertise combine rather than compete. That synergy is the strongest argument I know for why we members of GLMS should keep pushing this conversation forward.
I’ d love to hear from GLMS members about collaborative models you’ ve built or wish existed in your own practice. This column works best as a conversation, not a monologue.
Dr. Bhatia is a Retired Professor of Cardiac Anesthesia at the University of Louisville and a retired member of the Scientific Committee of the Society of Cardiac Anesthesia.
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