Many different types of doctors are often involved in preventing or treating stroke. This can include providing medications to control risk factors like high blood pressure or diabetes to diagnosing and treating stroke once it occurs. Click here for more information about stroke risk factors.
The treatment of stroke, from the initial onset, through post-hospital care can involve a team of physicians from multiple different specialties. These can include:
- Family Medicine (primary care doctors)
- Emergency Medicine
Any of these doctors can be responsible for medical malpractice if their negligence causes a stroke or makes stroke worse through a delayed diagnosis or misdiagnosis.
Family medicine physicians, often called primary care physicians or “PCPs,” tend to have the most contact with their patients of all types of physicians. Family medicine doctors often treat cold and flu while providing routine checkups, they may also be the physicians most likely to diagnose patients risk factors for stroke like high blood pressure (hypertension), high blood cholesterol, and diabetes.
To prevent stroke, primary care doctors may prescribe medications to lower blood pressure and cholesterol. They may also provide medications to control diabetes.
Primary care doctors also play a critical role in referring patients to specialists who can provide greater treatment to patients. These may include cardiologists if a patient is suspected of having a congenital heart defect, atrial fibrillation, or other cardiac risk factors for stroke. Likewise, primary care doctors may be the first to notice “warning strokes” called transient ischemic attacks (TIAs), which are often precursors to more major strokes. TIAs require prompt treatment and follow up.
Endocrinologists are doctors who specialize in treatment of disorders related to the glands. Among many other conditions, endocrinologists treat diabetes mellitus. Diabetes is a major risk factor stroke. If an endocrinologist fails to treat diabetes properly and this causes the patient to suffer a stroke, the doctor may be responsible for malpractice.
Cardiologists are specialists who diagnose and treat diseases of the heart. Many cardiac conditions can cause strokes. Atrial fibrillation is a heart rhythm disorder that can cause a person to develop blood clots that can cause strokes. Patients with atrial fibrillation require anticoagulant or antiplatelet therapy to prevent blood clots.
Patients with congenital heart defects may be at risk of suffering a stroke if surgical treatment is not provided to correct the defect.
Patients with high blood cholesterol may develop arterial stenosis or hardening of the arteries. This means that plaque begins to form on the inside of the arteries and reduces blood flow to the brain. Pieces of this plaque can also become dislodged and create a blockage causing a stroke. Cardiologists can take steps lower cholesterol or increase blood flow in arteries through stenting and angioplasty.
Neurology is a medical specialty dealing with disorders of the nervous system. To be specific, neurology deals with the diagnosis and treatment of all categories of disease involving the central and peripheral nervous system; or equivalently, the autonomic nervous systems and the somatic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. A stroke fellowship is frequently attained and is an essential part of training for neurologists interested in gaining expertise in the diagnosis and management of complex problems involving the cerebrovascular system.
In the case of acute stroke, it is the ER physician’s responsibility to coordinate the collaborative effort amongst many physicians for the benefit of the patient. Also, in most cases, the first physician that the patient encounter is in the ER. That physician has the responsibility of gauging the severity of the patient’s stroke and how to proceed from there.
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies (such as X-ray radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI)) to diagnose or treat diseases such as stroke. Interventional radiology is the performance of (usually minimally invasive) medical procedures with the guidance of imaging technologies to remove clots or clip aneurysms stopping ischemic and hemorrhagic strokes before major damage occurs.
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinalcord, peripheral nerves, and extra-cranial cerebrovascular system. Occasionally, neurosurgeons may be called in to assist in a stroke case that may necessitate surgical intervention. An example would be clipping a hemorrhagic bleed via endovascular therapy or open craniotomy.
Physical Medicine and Rehabilitation
Physical medicine and rehabilitation (PM&R), psychiatrist or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a psychiatrist or rehabilitation medicine specialist. Psychiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).
Consultations in Stroke Diagnosis and Treatment
An experienced professional who is sufficiently familiar with stroke or a stroke team should be available within fifteen minutes of the patient’s arrival in the ED. Often, occupational therapy, physical therapy, speech therapy, and physical medicine and rehabilitation experts are consulted within the first day of hospitalization. Consultation of cardiology and vascular surgery or neurosurgery may be warranted based on the results of carotid duplex scanning, neuroimaging, transthoracic and transesophageal echocardiography, and clinical course.
During hospitalization, and when a patient returns to home, additional useful consultations of often include:
- Home health care coordinator
- Rehabilitation coordinator
- Social worker
- Speech language pathology
- Physical Therapy
- Occupational therapy
- Psychiatrist (commonly for depression)