I am always happy to give advice to friends and family, particularly on navigating the health care system.  While being underinsured is obviously a problem, having great insurance comes with its own particular challenges.

It would seem liberating and well, just better, to not have a “gatekeeper” policing your use of specialists and expensive medications.  Sometimes, indeed it is, but it depends.  And sometimes, seeing a specialist is the obvious route.  Ideally you are under the care of a primary care provider who will take the time to look at your case holistically and advise you about when to consult a specialist.  But sadly, the system is set up to not give the provider the luxury of time to do this easily in many cases, and a referral to a specialist is sometimes a way of passing the buck, even if that is not the intention.

Okay, I’m going to say it.  Specialists sometimes have tunnel vision, and this is understandable.   A provider sent someone to see them, indicating at least that they suspect the problem is in the specialist’s particular field.  But medicine is at times as much art as science, I’m afraid, and that is not always the case.  It could be more like a best guess, or even a scattershot approach –  fainting spells: neuro or cardio? Let’s do both. 

And while in the end, the specialist may report that the problem is not in his or her specialty —  your heart is fine, or your lungs, or your kidneys —   usually there are a lot of expensive and sometimes invasive tests, involved in coming to this conclusion.

I’d like to spare you this. If you have a new subtle symptom, by all means make note of it, when it began, what makes it worse or better, and simply observe for 2 weeks.  Note – and this should be common sense — fainting, chest pain, signs of a stroke like facial drooping or slurring words, severe pain of any kind, prolonged blurry vision, blood in urine or stool are not subtle and you should see someone right away.  Basically, if the symptom scares you, see someone right away.  But if it’s just a newly observed sensation, you may want to wait a little to see if it goes away on its own.  I’ll give you an example of what I mean.  When I was in nursing school, I developed, or should I say noticed, many new symptoms.   My leg throbbed at odd times.  I felt, if I really dug in, some weird bumps under my skin in certain places.  My knees sometimes made a creaking sound.  If I moved just a certain way, kind of like a cha-cha step, I got their strange pain in my hip for a moment.  My doctor would dutifully take note but also wisely took a wait and see approach.  And the next time I saw her, she’d ask about it and more often than not, I’d forgotten all about it.

There is a reason why the majority of health care providers do not utilize as much health care as non-providers.  Sure, they have more knowledge of the human body, but it’s more than that.  We know that every test we order has to be followed.  And the more tests you order, the more abnormal results you will find, that you may not have even been looking for, have nothing to do with the original problem and may have no effect on the patient’s future health.   But now you have to track every one of these down.  You might never find the answer – art vs science, remember? — but a lot of hours have been spent in its pursuit.  While many people want to have as many tests and imaging studies as possible as an assurance that “everything is okay,”  too often they don’t get this reassurance and in fact, might get more to worry about, whether justified or not.  It’s the reason I am leery of those full body scans that are marketed to the public, but that’s another issue. For now, the message is, don’t run blindly from one specialist to another without “looking both ways.”  Form a relationship with your primary care provider and make those decisions together.