What to do when you think it’s time to bring in a specialist.

Rosa has had the same primary care physician for over 20 years.  She has not only given Rosa her annual check-ups, but has seen her through pneumonia (twice), poison ivy, a few viruses, and virtually every other medical issue that has arisen during this time.  Last week, Rosa’s doctor diagnosed her with a chronic condition.   When Rosa received her diagnosis, she felt really scared.  But her doctor reassured her that her condition was treatable and recommended a course of treatment.


Rosa felt confident that she was on the right path until she started doing some research on her own.  A few of the trusted resources she checked out on the Web described the latest treatments for her condition, which don’t include the approach her primary care physician has recommended.  One source even described her doctor’s recommended treatment as outdated.  Furthermore, a test that her doctor had scheduled her for, to monitor the progression of her condition, was longer described as unnecessary, and even overly invasive, by the leading experts.


Based on her own research, Rosa has decided that she needs to be working with a specialist in her condition, whom she feels would be more qualified to treat her effectively.  But she has a long history with her primary care physician.  “How can I betray her like this?” Rosa asks herself.


Considering the need to consult a specialist in your chronic condition?  Here’s how to get started:


Keep in mind that your physician is a professional, not your best friend.  Relationships between patients and their physicians develop over time.  While they are built upon trust, it’s only human to also make a personal connection with your physician.  This can feel a lot like friendship.  However, the relationship between you and your physician is a professional relationship first and foremost.  The emotional connect certainly enhances the relationship, but doesn’t define it.


Think of working with a specialist as adding a new member to your healthcare team.  As your healthcare needs change and grow – and potentially become more complex – you will most likely need additional expertise on your team.  So envision a specialist as supplementing your primary care physician’s expertise, not as replacing it. This will help you to decide what specialist to work with, as well as guide how you work with both your doctor and the specialist you choose.  This is not an either/or decision.


Do your homework.  Explore the websites of associations that are focused on your condition, like the American Diabetes Association or the American Lung Association, to learn about recommended treatments and testing.  Check out consumer sites of trusted authorities like the Mayo Clinic.  Search for specialists in your area, in private practices, or at nearby universities or treatment centers.  Where possible, talk to other patients with your condition and see if they have recommendations.


Take the direct route.  Consulting a specialist is not the same as criticizing your primary care physician’s approach, nor does it or imply that he/she is incompetent in any way.  So approach the conversation by emphasizing that your decision is based on a desire for the perspective on treating your condition that a specialist brings to the table, not a lack of trust.   Assume that your physician wants the best for you.  Chances are, your doctor has had this discussion with patients in a similar situation and may welcome the idea of having additional input into your care.  You may even want to ask your physician for suggestions on specialists in your condition that he/she trusts.


Keep your primary care physician in the loop.  Ask the specialist to keep your physician informed of his/her recommendations.  If possible, encourage them to have a conversation about your case, and to remain in consultation with each other going forward.  After all, your doctor knows your medical history and has insight that will be valuable to the specialist that you choose to involve.  Your primary physician may even want to make the initial contact with the specialist.


And if your doctor takes things personally, stand your ground.  Primary care physicians aren’t always open to the involvement of a specialist.  Your doctor may be treating other patients with your condition, and feel perfectly qualified to treat you.  Or he/she may be concerned that another doctor will not treat you with the same level of dedication that they have been treating you, or that you will be “lost” in a less patient-focused practice.  If you encounter resistance, some reassurance of your continued trust, coupled with the reminder that this is a decision that you have made, may be in order.  You are in charge of your healthcare.


Here’s what how Rosa did about her decision to work with a specialist: After doing her research on treatments, she called a few friends who connected her to other friends, which helped her to zero in on a couple of highly regarded specialists.  Rosa sat down with her primary care physician and informed her that she wanted to add a specialist to her team.  She gave her the names of the specialists she was considering, and asked her doctor if she had worked with any of them, and also if she had any suggestions.  Rosa was happy to hear that her doctor supported her decision and especially recommended one of the specialists, whom Rosa subsequently chose to work with.  Rosa is confident that she has the best possible healthcare team in place.


As your healthcare needs evolve, so should your healthcare team.  Give yourself permission to make decisions about the expertise that you need on your team.