Primary Care Physician or Specialist? 4 Things to Consider

While a primary care physician often take the lead in preventive care and wellness, they also can treat health conditions that require ongoing maintenance.A primary care physician (PCP) can play a pivotal role in your health care, and are often the first point of contact you have with the health system. While PCPs often take the lead in preventive care and general wellness, they also can treat many health conditions that require ongoing maintenance. These may include allergies, hypertension, high cholesterol, diabetes, and mood disorders, to name a few.

However, certain conditions may lead your PCP to refer you to a specialist, a physician with focused training in a specific area in the field of medicine.

There are 4 reasons you may be referred to a specialist:

You have a complex ongoing condition.

Many primary care physicians are skilled at managing ongoing health conditions – often referred to as chronic conditions – including diabetes, arthritis and high blood pressure (hypertension). However, some diseases need a higher level of expertise in a medical specialty to provide treatments. You also may suffer from a more severe form of a disease that may put you at greater risk for a more serious health crisis.

For instance, a PCP may be able to help you with single kidney stone attack that keeps you out of work for a few days. But if you have multiple kidney stone attacks in as many months, or have a large kidney stone that is obstructing urine, there may be a deeper underlying problem. Your PCP may refer you to a nephrologist or urologist, doctors who specializes in kidney care and diseases that affect the kidneys and bladder.

You’re dealing with a rare disease.

When you have a rare disease like cystic fibrosis, a specialist can provide more resources for treatment and will likely be aware of the newest therapies available. By definition, a rare disease affects fewer than 200,000 Americans. Since your PCP functions as a health care generalist, he may not see your condition enough to fully manage it on his/her own. However, primary care physicians can work with a specialist to help fully manage the disease.

You received a life-altering or life-threatening diagnosis.

Certain medical conditions can mean you need to make significant lifestyle changes. Diabetes can mean insulin shots at regular intervals during the day, as well as significant changes in diet and more frequent visits to your doctor to monitor your condition. A stroke can require ongoing therapy and physical modifications to your home. It can be worth a visit with a specialist to assess your diagnosis and fine tune your treatment options.

Current treatments don’t seem to work

If a health problem persists in spite of a treatment that normally works or you have a set of symptoms that don’t make sense, you and your PCP may decide you need a specialist to take a deeper look at what may be affecting you.

Finding a specialist

Ask your primary care provider to recommend a physician who is in your health plan, or check your insurance plan’s list of physicians to see who participates and ask for a referral based on that list.

Related articles:
What is a PCP and Why Do I Need One?

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