by Betty Long, RN~Though primary care physicians and nurse practitioners are intended to be patients’ first point of entry into the healthcare system, approximately 7 out of 10 people in U.S. commercial health plans (and 95% of the elderly) see one or more specialists in a year.
Many years ago, managed care plans intended to control visits to specialists, and some plans still require a referral from the primary provider, but for the most part, if you need a specialist, you can see one. So when you do see one, it’s important to know how to interact with them, to make your visit more effective and more helpful.
As a basic point of information, a specialist has undergone the basic training of all medical doctors, which includes four years of education in a college or university followed by four years of medical school and an M.D. degree, followed by at least three years of training under supervision, called a residency. Physicians who elect to specialize in a particular area of medicine then continue their training for an additional two to five years. Examples include cardiologists (heart), orthopedics (skeletal system – bones, muscles, joints) and endocrinologists (thyroid, diabetes). While these physicians are highly trained, they focus on very specific body systems that will be their primary area of focus when examining and treating you. Since you have a complex body made up of multiple interdependent systems, recommendations need to be integrated into an overall plan that takes into account all the other conditions that you may be managing.
Though it is ultimately your responsibility for preparing for any healthcare appointment or visit, you can certainly review your goals for the visit with your primary provider. After all, it is often they who suggest that you see a specialist. Here are a few things to consider before going to a specialist:
- What is the goal? What information do you hope to gain from the visit? What type of specialist are you seeing and what is his/her expertise?
- Whom do you want to see? Although your primary care provider may have suggested a colleague, the ultimate decision is yours. Conducting research on the skills, experience and background of healthcare providers on your team is your responsibility.
- Will your insurance cover the visit? Do you understand the requirements of your health insurance? Is a referral or prior approval for specialty care required for coverage? If so, what paperwork is needed to prevent a complicated claims issue? Is the provider “in network?” If not, what is your financial responsibility?
- Who communicates? How does your primary care provider plan to communicate relevant information to the specialist? Be sure the communication is in writing, and that it includes a review of your medical history, current medications, the reason for the referral, and all relevant diagnostic testing results. Also, do you need to pick up a copy of the results and hand-carry them to your appointment?
- When? If your primary care provider’s office set up the appointment with the specialist, are you comfortable with the amount of time between your next visit with your primary care provider and the specialist? If you would like an expedited appointment, it is usually more effective to have your provider’s office call and make the request.
- What next? Do you have a follow-up visit scheduled with your primary care provider to discuss the specialist’s treatment recommendations?
As suggested before, when you have any interaction with a provider in the healthcare system, being prepared helps to reduce fear and anxiety, allowing you to speak more openly and listen more effectively. A written agenda, prepared ahead of time and reviewed at the beginning of the visit, helps you to manage the meeting. It also increases your chances that you’ll leave satisfied with the visit. Though it may seem initially awkward, consider creating one.
Below is a sample agenda for a person seeking a specialist’s assistance (an endocrinologist) with management of her diabetes:
- To seek an expert opinion on the management of my diabetes care.
- Why I selected you as my diabetes specialist
- Communication methods within your practice~ Developing a solid communication plan and a positive relationship with all my healthcare providers is vitally important. How do I get test results as quickly as possible?
- My history What do you know about me so far?~ Did my primary care provider communicate my history and the reason for this referral? If not, I’ve brought along a written medical history.
- Current medication regimen~ Is it adequate? Are there alternatives? I’ve also brought along a written list of my prescribed and over-the-counter meds, those taken on an “as-needed” basis, supplements, and those previously prescribed.
- Preventive care ~Am I doing all I can to prevent complications of this disease?
- Ongoing care~ Do you see the need for me to see you intermittently, or will my primary care provider implement your recommendations and manage my care in an on-going manner?
- Healthcare goals~ How do I continue to educate myself about my disease?
Plan of action/next steps
If you are having trouble developing an agenda, don’t hesitate to ask for help from your primary care provider. The important thing is that you take ownership of your care because you are the best person for the job!