Do you prefer to see or ask your primary care physician first, or immediately seek out a specialist?

[ucbalumnus]

In another thread, we had a side discussion…

@nyc10023

I don’t (knock wood) have any major health problems but I see 5 specialists! Middle aged sports injury - ortho. Don’t love my cholesterol numbers - cardiologist. And various others for unrealized problems.

@ucbalumnus

My impression is that blood cholesterol issues are so common in the US that every primary care (general / internal / family) physician is very familiar with them, so why would a cardiologist be needed if that were the main issue (as opposed to more unusual cardiology problems)?

@nyc10023

I don’t need a specialist, but I WANT one just because. And in doctor-saturated NYC, I can get one (actually I have 2) - maybe a little hypochondriac here. My point is I can get one. And that drives up the costs. Because maybe I shouldn’t be able to see one so easily.

@ucbalumnus

I would not assume that having a specialist for a common condition that primary care physicians see lots of every day adds any value to me as a patient (even though it may cost both me and the overall health care system more). A disadvantage is that multiple physicians can prescribe care without coordination with others, resulting in unwanted interactions or polypharmacy issues.

As you can see, I have a different opinion from @nyc10023 here. Since people in this forum section have talked a lot about medical care, what is your preference in answer to the title question?

[busdriver11]

That’s one of the “it depends” sort of issues. I really like my PCP, so if I’m looking for a specialist, I shoot her an email and ask her whom she recommends. She will usually give me someone great to see, but occasionally she will tell me to come in first. I guess I’m usually making the call on a specialist, not her, as my insurance covers it all.

Recently I injured my back. I went to see my PCP first, and only to a specialist if she suggests it. I had some odd heart related incidents, so I went to a cardiologist first (all is good). Maybe people go to cardiologists at the first sign of trouble because heart problems are common and can be serious.

[ChoatieMom]

We haven’t had a PCP in several years because there aren’t enough of them down here where we moved (impossible to get scheduled), so I found a local OB/Gyn to issue an order for annual mammograms, a dermatologist for an annual skin scan, an opthomologist for eye exams and, when my hip gave out last year, I researched ortho docs and got that surgery scheduled and done. Last December, we finally decided to stop looking for PCPs down here and went back to our old one an hour north of us. Because we don’t have any complicated health issues, just BP and statin meds, we don’t mind making an annual well-visit trip or just scheduling a teledoc call. Because we have a long, trusted history with our old PCP, we’ll start with him for any future specialist references.

[nyc10023]

So I have been getting my annual bloodwork done since my 20s.

I think i eat well (get better with age). My weight has been the same, good bmi since my mid 20s.

Run/hard cardio 4-5x/week.

Excellent numbers until mid 40s when cholesterol, BP started to inch up.

I am not one to go into my PCP with reams of research.

PCP did the usual - changes with age, blabla, genetics.

I was the one who pushed for meds because unlike most people, my BP was higher at home.

All well and good. A few doctor friends of mine suggested that it might be good to dig further into the BP thing given my fitness level. I kinda ignored this.

I started to hear more about relatives who had heart issues but excellent blood work. At the same time, Ldl started going up. Doc was watching it but just said to go on statins if it got higher. Again, good diet and lifestyle so probably genetics.

I got the gold standard angiogram anyway through a cardiologist highly recommended by friends. All good, but given possible family history, maybe just to redo tests every 5 years. This is different from pcp but not in conflict. All good.

Then another adverse event happened to a closer family member and some googling revealed that the midlife BP rise might be related. I live in nyc, land of docs, called an academic research center doing genomics and am qualified to enter their study. So i do, another set of specialists. They have a different take on the BP - no change in treatment but it’s slightly more alarming to them so they suggest i come in every 2 years. As they discover more things, maybe there is a different protocol. Blabla.

Ortho - i run a lot. I go to ortho so i can get a prescription for PT and then i can get insurance to cover. I don’t think the pcp would have done the checks that the ortho did or written the script.

So i don’t think i am getting conflicting treatments, just more information that may change my trajectory.

As to the statins, despite no advice from the pcp to do so, i have been experimenting with my diet and paying for lipid tests out of pocket to see what the effects are. So, it turns out, i won’t need statins (and the cardio agrees). Just depends how hardcore i want to go with my diet.

So i respect my pcp but they run a certain protocol that may not be finely adjusted for an individual.

I just realized that I didn’t answer. I did see my pcp first but then sought specialists for further tests and maybe a change in treatment down the road.

[momofboiler1]

I go to my primary care doc first unless it’s for something where I need an orthopedist.

[1NJParent]

I have quite a few physicians and nurse practitioners among my closest friends. They can almost always give me more candid, detailed and better explanations of what I may have experienced medically than my PCP, so I practically never use my PCP for anything other than annual physical. I even rely more on my friends than my PCP to interpret the results of my checkups for the same reasons I gave above. My suspicion is that I can now get equally good advices from AI technologies. From insurance companies’ perspective, PCPs are still necessities currently because they act as gatekeepers under most of their plans. But I imagine that insurance companies will use AI in the future for that purpose, at least for the initial diagnoses to determine whether referrals are necessary.

[nyc10023]

I am a numbers person and now i have discovered the joy of labcorp on demand tests.

[1214mom]

I see primary care doc twice a year, mostly for blood work.
I have gyn for that stuff. Same one since he delivered my babies.
I feel like we have family plan with ortho.
In my 20s I had an eye disease and had a significant chance of going blind. Still see ophthalmologist at least every couple of years.
Derm for cancer checks each year.
Finally decided to get tested by allergist last year. Won’t need him much in future.
My pcp will tell me I’m the healthiest person she sees the days I go, but still a fair number of specialists, and usually I just go on my own, without seeing primary first.

[nyc10023]

@1214mom

Derm for cancer checks each year.

Ah yes, we get those.

Nobody in Canada get these checks that I know of, either by FP or derm. Nobody sees derms for the things they do here. Our kids’ pcp immediately referred them to derm for mild acne. In Canada, FPs prescribe accutane.

I was lucky enough to architect the corporate insurance plan we are on. It’s a HDHP PPO for which we pay $1/month:)

[compmom]

I almost never see my PCP to the point that I made an appointment just to go over things, because I see specialists and make decisions on my own. Patient forums have been the most helpful to be honest.

[abasket]

I think a PCP has an important role and is helpful to have on your roster. If you don’t have one, who do you go to for say a respiratory infection or cough?

I would also say that if you don’t think your PCP is helpful, maybe time to shop for a new PCP. Not to knock older PCP’s but they can be more traditional and “basic”. Newer PCP’s should not only treat but promote wellness. I like my PCP (she’s newer to me after a couple of PCP’s I didn’t really vibe with) as someone who helps me identify and triage both concerns and wellness. She is sort of the “organizer” of my health care and any specialists branch off from that.

[nyc10023]

@abasket

If you don’t have one, who do you go to for say a respiratory infection or cough?

Yes, depends on if you are prone to them (knock wood again!)

One day we’ll find out why humans are so different in their susceptibility to different diseases.

My spouse gets sniffly colds, lingering coughs.

I never get those, but get terrible sore throats that are never strep.

I get body aches - spouse does not.

I don’t have measurable fevers even when I’m burning. Our kids also measure cold.

One of them gets the lingering coughs. None get my wicked sore throats.

[deb922]

A good PCP is great as a gatekeeper.

I don’t have many medical issues so seeing my PCP is mostly a yearly thing. Go over my blood work and determine what I need. I now take medication for my higher blood pressure. My PCP is new and this year I think I will forgo the GYN and have her do what is now a 5 year routine Pap smear. She makes sure all those routine tests are done and all those vaccines are up to date. So I schedule those colonoscopies and mammograms. I see a dermatologist because of past skin cancer and I’m in that queue so no need to follow up with that. But a PCP serves a purpose and that purpose is for continuity.

My husband has more complex medical issues and his PCP serves a different function. He sees specialists for the stuff that is wrong. But the PCP has all the information in one place and can address any problems that will occasionally pop up. He was in the hospital recently and had a weird issue come up that he went to the PCP for. It was addressed but the doctor noticed that husband had some genetic screening done. PCP noticed that some additional screening should be done and made the necessary referral.

This is getting long . But if you never see a PCP, then I wonder how easy it is to keep up with those tests that are infrequent but necessary. I’d hate to find out later that I’ve missed something routine. Such as a colonoscopy or high blood pressure or high cholesterol. I also know that specialists can be myopic and address what they are experts at and not looking at the whole picture.

This is how medicine works in theory, doesn’t always work in reality. I think my husband and I are lucky to have found good PCPs

[thumper1]

I think the answer is…it depends.

I have a derm, ophthalmologist and orthopedist who I contact directly. No PCP involved.

I see my PCP for annual check up, and blood work.

[ucbalumnus]

@thumper1

have a derm, ophthalmologist and orthopedist who I contact directly. No PCP involved.

I see my PCP for annual check up, and blood work.

Question for those who go directly to specialists: do you keep your PCP informed about your specialist visits (or are they in the same medical group with shared medical records)?

[nyc10023]

Yes. It’s easier now that Weill Cornell and Columbia use the same epic health records system.

[bluebayou]

I’m in the ‘depends’ camp too. (And purposely chose a PPO over a managed care plan for that reason alone.)

If a medical issue pops up for something (ankle/knee) that relates specifically to someone we already have a relationship (ortho), we’ll call their office directly. Ditto Derm or ophthalmology or gastro or even general surgery. When we complete the patient questionnaire, we always list our primary care doc’s name so he’ll receive a report.

OTOH, if it’s something for which we don’t have a relationships with a specialist, we’ll call the primary care doc. Basic blood work is reviewed by primary care doc.

[ChoatieMom]

@ucbalumnus

Question for those who go directly to specialists: do you keep your PCP informed about your specialist visits (or are they in the same medical group with shared medical records)?

We have online accounts with our PCP’s practice and use the portal to enter updates, such as vaccines, specialist visits, surgeries, etc. When we visit or teledoc, he has access to all our records, including any imaging, from his iPad.

[Creekland]

Now that my son is an official doctor, I run everything by him first. I have yet to have to go to a doctor from newish things as he has given other suggestions (exercises, painkillers, etc) that have worked.

For the major things I have (and have had) going on it’s mainly a “wait and see” time period. With those I started with a specialist and from there was told to get a PCP to keep up on everything.

[cbreeze]

I have a great PCP and I go through her for most things. I do want her to be the gatekeeper and keep her in the loop on my specialist visits. DH is a physician too so he’s my second opinion.