Which doctor do you call?
May 20, 2019 9:43 AM   Subscribe

This is a general question about how to manage multiple health providers and medical continuity. If you have a health condition (e.g. diabetes, asthma, pregnancy, etc) for which you see both a primary care doctor and a specialist (e.g. endocrinologist, pulmonologist, ob-gyn), when do you see your primary care dr and when do you see the specialist?

I originally started seeing the specialist because my primary care doctor, an MD, wanted a second opinion and referred me out, but the specialist’s office also has a nurse and a triage line and encourages well visits and follow-ups. These are different practices with different scheduling staff and nurses. I know that if I, say, sprain my ankle, I should call my primary care. And I also know that if the specialist prescribes a medication I should see the specialist for medication management. But what if I am having a symptom flare-up, or I’ve gotten sick with the flu and that’s causing extra problems with my health condition? Should I call the specialist’s office, or my regular doctor? And if I meet with one, am I supposed to update the other on what happened?
posted by epanalepsis to Health & Fitness (9 answers total) 4 users marked this as a favorite
Once you have a specialist that's covering one part or system of your body then you can just bring all of that stuff to them and keep your primary care doc up to date when you go in.
posted by bleep at 9:58 AM on May 20, 2019 [1 favorite]

My medical professionals share an electronic health record (mostly) which makes life easier.

My rule of thumb is:
- If it's something the specialist prescribed or is directly related to that treatment, start with the specialist unless otherwise told. Update my primary care as needed.
- Other stuff goes through my primary care and I check to see if the specialists need to know.

I see my primary care 4 times a year for blood work and monitoring of stuff, so I often just make a note to tell her next time unless it's something that may affect ongoing care. (In which case, I send a message with the messaging service.)

I've had a couple of things where the specialist went "Here's this thing, you don't need to come see me unless it doesn't improve" and my primary care can take over refills on that.
posted by jenettsilver at 11:01 AM on May 20, 2019 [2 favorites]

If you have multiple specialists, it's useful to have a primary care doctor willing to coordinate or serve as a focal / reference point in treatment. Specialists are often loath to go beyond their specialisation, even when there are common underlying aspects (e.g. with autoimmune conditions) but that can turn a patient into their own case manager, having to verify that specialist X has passed information on to specialist Y. Not all primary care doctors are comfortable being de facto case managers, but if you can find one who'll take on that role, it lifts a huge burden.
posted by holgate at 11:21 AM on May 20, 2019 [1 favorite]

My experience has been: if your specialist was surgical, s(he) is at the top of the food chain, and others defer, otherwise it seems as if they all set their own agendas, but you really, really want your PCP to be kept in the loop one way or another, even if just to give informed answers to any questions you may have.
posted by Chitownfats at 12:28 PM on May 20, 2019

I think this can also depend on the relationship with your doctors. For example my GP is the first person I call/go to unless I know it's a very specific specialist follow up. But I will also sometimes call/email her to see if she wants to see me or would rather I start with one of my specialists. (Most doctors will take/respond to messages if you call in and have a day or two to hear back or the front staff may know when you call and describe your problem.) For most things I go to my GP because she knows me and my conditions well and we have a very good relationship.

If your specialist encourages you to come in for things tangentially related to your specific illness and you have a better relationship with them, then by all means call them! A huge part of medical care is the relationship aspect.
posted by Crystalinne at 12:33 PM on May 20, 2019 [1 favorite]

For me, if the treatment plan is stabilized, I stick with my PCP to manage refills, ect. If something new is going on with the condition I see the specialist.

If it's something that could be both or I'm not sure, I just go with the first available appointment .
posted by AlexiaSky at 1:34 PM on May 20, 2019

I rely on my primary. He knows my history with specialists, some of whom have treated me badly, and helps me manage those conditions. I don't ask him to contravene a specialist's treatment, but I do discuss it with him if I feel like doing it myself.

My primary is walking distance from my house, and has always been good about seeing me on short notice. The only aspect of his care that I have reservations about is that he is affiliated with a local hospital that's not so great. I've been going to a better one that's farther away. They are good at automatically sending all test results, etc. to my primary. I tried seeing a cardiologist in an even more distant famous Boston hospital, but it did not work out well. They are also stupid about sending records to anyone outside their syndicate. I have to send them a written request.

Bottom line is that I have confidence that my primary genuinely has my interests at heart. That has not always been the case with specialists.
posted by Kirth Gerson at 1:47 PM on May 20, 2019

I have three specialists, and a primary. My primary is my first go to usually, since he has my health history, and he will refer me back to a specialist if needed. One of my specialists is an endocrinologist (because I only have half a thyroid), who I see 3x a year. During those check ups, she asks me about my health history, and she orders tests if she feels my symptoms are endocrine related. If the tests come back "normal", then she sends me to my primary for follow up (usually though, they are endocrine related).

I trust my primary because he knows my whole body health, and we have a good rapport, whereas the specialists are just that - specialists for a specific condition.
posted by alathia at 1:52 PM on May 20, 2019

From the other side of the exam table... as a subspecialist with a cadre of patients with chronic progressive diseases, I tend to focus really tight on my specific sub-field, because I have spent the last 10 years studying, treating, and researching almost nothing else. I no longer have any clue what's the best antibiotic for pneumonia, or how to tinker with blood pressure medications.

In the specific situations you mention: an unexplained symptom flare-up should be managed by your specialist, but a symptom flare that seems to be because of flu (or whatever) should be managed by your PCP with a heads-up to the specialist in case there's a temporary adjustment in your meds.

If someone brings up a concern that isn't related to my field, I just acknowledge my limitations and ask them to talk with their PCP (or if it sounds like it would be related to one of their other specialists, with that person). Particularly if this illness is new to you, it may take a while until you figure out the way it impacts you.
posted by basalganglia at 3:08 PM on May 20, 2019 [1 favorite]

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