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Primary care physicians recommend what patients should know before heading to a medical specialist.
When is your family doctor the right choice? When do you need a specialist? It is a question patients often have — and one their primary care physician can help answer.
Doctors, both primary care and specialists, will tell patients that the best and fastest way to see a specialist is to head to a primary care physician. Many issues that patients may believe require a specialist can actually be handled by a primary care physician or internist, says Dwight Hardy, a primary care physician at Mingo Valley Medical Group.
In fact, a primary care doctor can take care of about 95 percent of problems, says Peter Wenger, a primary care physician with OMNI Medical Group. That classification includes internal medicine doctors, family practice doctors and pediatricians.
Patients, he says, sometimes think primary care physicians are a barrier to seeing a specialist and are trying to pad their pockets with more visits.
“The truth of the matter is, we’re trying to give them the best care and treatment in a timely manner,” Wenger says.
If a primary care physician encounters a problem beyond his or her scope of knowledge — such as a heart patient needing a catheter inserted or a patient with a difficult case of diabetes — the doctor will refer the patient to a specialist, such as a cardiologist or endocrinologist.
Steve Landgarten, an internal medicine physician at Utica Park Clinic, says physicians refer when a patient is best served by a specialist.
All physicians go to medical school for four years and have at least a year of residency, he notes, but some specialists have fellowship training in their particular area of interest several years beyond that.
Primary care physicians can refer and recommend the best specialists in the area, says Landgarten, who is also the chief medical officer for Hillcrest HealthCare System. Landgarten looks for specialists who can see the patient promptly, have a good rapport and have proper training.
Wenger says doctors establish relationships over time with specialists, in addition to getting feedback from patients who worked with the specialist.
For example: “‘Dr. X didn’t have a very good bedside manner,’ or ‘I didn’t feel comfortable with the treatment he was recommending.’ When you hear that enough, you generally won’t send that many referrals to that physician,” Wenger says. “Likewise, when you have positive feedback, you send them back more.”
Outside of patient feedback and relationships, before referring a patient to a specialist, primary care physicians also look at the patient’s health insurance options, Wenger says.
“We have to consider patients who are often locked into a particular network with their insurance, especially with HMOs,” he says. “For example, there are certain physicians they can see and others that are considered out of network for which they’d have to pay a higher co-pay or couldn’t see at all.”
Occasionally, patients may have to see someone outside the network if no specialist is available within their particular network, but, Wenger adds, that rarely happens.
However, doctors realize that not all people will go through a primary care physician before seeking out a specialist. Many times patients take matters into their own hands, thinking they are doing what is best.
For example, Robert Gray, medical director of OMNI Medical Group, says he might come across a parent whose teenager has acne and believes he or she needs to go directly to a dermatologist.
If the parent chooses to bypass the primary care physician, Gray says that having the right information is important.
“What you’d really like is better information on the Internet … to make a good decision about that,” he says. “There are businesses that have sprung up attempting to do that, but the data they have to work with is not that great for making reliable decisions.”
Gray says patients can easily go to the phone book or online and choose a particular specialist for a particular body part.
“But without someone sort of coordinating all of it, you could have one specialist inadvertently messing up a problem in another organ system because no one is really looking at the big picture or the whole patient,” he says, which is another reason why the doctors recommend a primary care physician who knows and understands the whole patient.
