What is a specialist?

doctorsApproximately seven of 10 people in U.S. health plans (and 95% of the elderly) see one or more specialists in a year. Looking at my own family, I saw one specialist last year, while my mother saw six. My clients, on average, see five specialists.

The bottom line is we must know how to interact with these partners in our care.

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), gynecologists (reproductive health for women), and orthopaedics (skeletal system – bones, muscles, joints and ligaments).

These physicians are highly trained individuals, but in a very specific bodily system that will be their primary area of focus when examining and treating you. But remember, you have a complex body made up of multiple interdependent systems, so recommendations need to be integrated into an overall plan that takes into account all the other conditions you are managing.

Be prepared

As you know, the primary responsibility for preparing for a physician appointment with a specialist is yours, just as it is for preparing to see your primary care physician. But be sure to share this responsibility with your primary care physician. He/she is usually the first to suggest that you see a specialist, and will often have a particular goal and colleague in mind.

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 physician may have suggested a colleague, the ultimate decision is yours. Conducting research on the skills, experience and background of physicians on your team is your responsibility.
  • Will insurance pay? 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?
  • Who communicates? How does your primary care physician 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 diagnostic testing results and hand-carry them to your appointment? What about medical records?
  • When? If your primary care physician’s office set up the appointment with the specialty physician, are you comfortable with the amount of time between your visit with your primary care physician and the specialist?
  • What next? Do you have a follow-up visit scheduled with your primary care physician to discuss the specialist’s treatment recommendations? Remember, your primary care physician knows you best.

Set the agenda

As with any patient-physician meeting, being prepared helps to reduce fear and anxiety, allowing you to share 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 ensures that you leave satisfied with the outcome.

Below is an example of an agenda for a person seeking a specialist’s assistance with management of his/her diabetes:

  • Objective
    To seek an expert opinion on the management of my diabetes care.
  • Discussion Topics
    • Why I selected you as my specialist
    • Communication methods within your practice
      Developing a solid communication plan and a positive relationship with all my physicians 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 physician communicate my history and the reason for this referral? Let me fill in the gaps by sharing my written list of my medical history.
    • Current medication regimen
      Is it adequate? Are there alternatives? Let me share my written list of 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 physician 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
  • Additional questions
  • Summary

If you are having trouble developing an agenda, don’t hesitate to ask your primary care physician to help!

Patient Centered Medical Home Model and Specialist Care

7y1u7f4jOne of the provisions in the “Affordable Health Care for America Act” is the planned movement of patients to a patient centered medical home model.

This concept is not new. The American Academy of Pediatrics coined this phrase in 1967, initially referring to a central location in which to house a medical record. In 2006, the American College of Physiciansexpanded the definition to include providing care that was:

  • Accessible
  • Continuous
  • Comprehensive

Historically, this was the opposite of what primary care physicians found themselves delivering as they were spending less time with more patients, and were unable to coordinate care in the 10-15 minutes they spent together. According to one study, specialists were also found to be spending more time each year on routine follow-up care for patients with common chronic conditions such as asthma, diabetes and lower back pain.
The patient-centered medical home model is designed to “reinvent” primary care and more effectively utilize the expertise of specialists – creating system-wide efficiencies by freeing up specialists to concentrate more on new patients and those with complex conditions.

Ideally, a detailed care plan constructed by a primary care physician – with input first from the patient, and then from appropriate specialists – leads to the primary care physician’s practice assuming the role for follow-up care. The specialist is consulted as needed. This collaboration has potential benefits including less fragmentation of care, in which a patient’s physician is not aware of what the specialists are doing. It also minimizes redundant tests and services, decreases overall costs and results in more satisfaction for the patient and the primary care physician.

From the consumer perspective, it makes perfect sense.

Next month, I’ll provide more detail on the patient centered medical home model from the consumer’s perspective.