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When Is a Specialist the Wrong Specialist for You?

Posted Feb 25th, 2009 by Trisha Torrey

When your stomach is upset and that upset just won’t go away, you make a visit to your primary care doctor.  Your primary care doctor, believing the cause may be more than just simple upset, refers you to a gastroenterologist.  Gastroenterologists take care of problems related to our digestive systems, so seeing a gastroenterologist for stomach upsets makes sense.

Now say your symptoms aren’t stomach upsets, but terrible headaches, or a tingling feeling in your hands or feet.  Your primary care physician, realizing that you may have a more serious medical problem, may refer you to a neurologist. A neurologist is trained to diagnose and care for problems with the head, neck, balance, reflexes and other problems including memory and cognitive abilities.

That gastroenterologist or neurologist may pull out all the stops in trying to diagnose you. She will gather evidence in a variety of ways by observing you and your symptoms, running tests and studying your medical history.

But she may still have a problem determining your true diagnosis. And, of course, without a true diagnosis, suggested treatment options may not help you. If you have something curable, and the specialist can’t diagnose you, then you may not be cured.  Instead, any treatment recommendations will be aimed at trying to alleviate symptoms.  Without a true diagnosis, a cure would be almost impossible.

Here’s an example: 

Helen found herself with real stomach upset for several weeks.  Her primary care physician sent her to a gastroenterologist. But the gastroenterologist just could not identify the problem with Helen’s digestive system.  So he prescribed an anti-depressant, believing that Helen’s problem was emotional, not physical. He discounted her upset, chalking it up to being “all in her head.”

Helen did feel better for a little while.  Actually, her stomach still bothered her a little, but the specialist had told her there wasn’t really anything wrong with her, and those pills made her feel better, so she just didn’t worry too much about it.

A few months later, Helen began vomiting.  No food would stay down.  She returned to her primary care doctor who admitted her to the hospital.  Several tests later, it was discovered that Helen had ovarian cancer.  The tumors were pressing against her digestive organs, causing the upset. 

It was too late to control the cancer, much less remove it or treat it.  Helen died having been misdiagnosed by the wrong kind of specialist.

If you have had trouble getting a correct diagnosis, consider the possibility that you have been seeing the wrong kind of specialist. In fact, that specialist’s knowledge of his specialty area will be so extensive and specific that he may not consider that your problem is based in another body system that he knows far less about.

Most of us patients are surprised that a specialist wouldn’t consider sending us to someone who could treat the right body system. We assume specialists have good knowledge of general health and body systems.  The fact is, a specialist spends only two years of his education on general medicine, and the rest of his education is focused on his one body system or disease specialty.  There’s a good chance that he won’t send us to another specialist because he doesn’t realize that’s what needs to be done.

There’s possibly a second dirty-little-secret reason you won’t be referred by a specialist to another specialist.  This won’t be true for all of them, but some will look at you as a profit center, not a patient. As long as you keep coming back to get your symptoms treated, even if you aren’t cured or relieved, then that specialist will continue making money from you.  In today’s money-based American system of medicine, that holds true way too often. The incentive system is set up to keep you coming back, not to send you to someone else.

What kinds of specialties can get mixed up? Here are some examples:

Headaches can be caused not just by neurological problems, but by sinus problems, infections, high blood pressure, dental problems, eye diseases, arthritis – hundreds of causes. Those problems are treated by ophthalmologists, endocrinologists, rheumatologists, dentists and others.

Stomach problems may have other causes than those related to your digestion, too. From liver problems to female problems to thyroid diseases; rather than getting a diagnosis from a gastroenterologist, you may need to see a gynecologist, urologist or an endocrinologist to get the right answers for you.

How can you know who else might be able to help you?

If you can’t seem to get the right answers from a specialist, then return to your primary care physician who can be your specialist coordinator. Make sure your PCP has copies of the records for the specialist you’ve already seen. Then ask what other body system could cause your symptoms, and ask to be referred to a specialist who takes care of that alternative body system.

Wise patients know that seeking information from other kinds of specialists may be the ticket to getting the right diagnosis.


About the author

Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at

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