Some health problems are so clear-cut or serious that, if insurance allows, it's worth going straight to a specialist. Someone with a history of skin cancer who develops a new lesion should see a dermatologist, for example.
But it's not always so straightforward, and part of your primary-care provider's job is to decide when a specialist is needed, says Marvin M. Lipman, M.D., CR's chief medical adviser.
While a neurologist may be necessary, say, for persistent migraines or an allergist to pinpoint allergy triggers, a PCP can often manage both.
Of course, sometimes a specialist's care is crucial. Here's when your PCP might refer you to one, or when you should ask to see one.
You receive a serious diagnosis. An oncologist is clearly needed if you learn that you have cancer, as is a cardiologist if you have a heart attack. But specialists also improve outcomes for certain other conditions, such as a neurologist for people with Parkinson's.
You have a complex problem. A PCP can handle, say, osteoarthritis, but you may need a rheumatologist for severe rheumatoid arthritis.
The diagnosis is unclear. Diagnosis can be difficult for uncommon problems such as cystic fibrosis. "PCPs encounter them so infrequently they may not recognize them," Lipman says.
You're not improving. Maybe back pain lingers despite anti-inflammatories and physical therapy. "If things aren't helping after a reasonable time," Lipman says, "ask to see a specialist."
A Guide to Specialists
Allergist/immunologist: For allergies, asthma, and immune-system disorders.
Dermatologist: For acne, eczema, melanoma, and other problems with skin, hair, nails, and the lining of the mouth, nose, and eyelids.
Endocrinologist: For diabetes, osteoporosis, thyroid diseases, and other gland and hormone disorders.
Neurologist: For dementia, brain injuries, epilepsy, and brain, nerve, and spinal-cord disorders.
Orthopedist: For injuries to and diseases of the bones, joints, ligaments, muscles, and tendons.
Otolaryngologist: For hearing loss, chronic sinusitis, and ear, nose, and throat (ENT) disorders.
Psychiatrist: For substance abuse and all mental health issues.
Non-M.D. Specialists: These include podiatrists (who focus on feet); chiropractors (with special training helpful for some back problems); physical therapists; and dietitians.
