Bird Flight

I had a good conversation with my general practitioner today. He confirmed my suspicion that seeing a slew of specialists will not necessarily make me a healthier person. For instance, when I complained that my nephrologist wants to see me every six months, my GP said my kidney function will almost certainly remain stable for the rest of my life (unless something significant happens), so why not just let him monitor it? Every year he orders a series of blood tests, which includes one that shows my kidney function. If he saw anything go amok, he’d certainly recommend I get the specialized care again.

I trust my GP, he’s a well-rounded, thoughtful doctor. I know he’d refer me to a specialist if he thought it was really necessary. Actually, when he referred me to a psychiatrist years ago, that was definitely a good recommendation. It eventually led to the most significant diagnosis I have ever received. Bipolar disorder. I was 32 years old at that time. But today, he went along with my decision to stop seeing my nephrologist. And my cardiologist (my EKG was apparently just fine).

I’m 45 years old now. It’s funny to think that when I was young, I only ever went to my general practitioner, and only when I actually felt sick. Maybe the dentist, on occasion, depending on whether or not I had dental insurance and felt anything was wrong. I brushed my teeth every day. Why suspect anything was going to be wrong unless I had a toothache?

It was when I turned 32 that all hell broke loose. I had a mental health crisis. I had been seeing a psychiatrist, but when the repeated hospitalizations started, my list of doctors kept growing. By the time I was 40, I had not only been to my general practitioner, psychiatrist, and gynecologist (the usual doctor crew for a woman with mental illness that age), but also an endocrinologist, cardiologist, nephrologist, anesthesiologist, dermatologist, nutritionist, psychologist, addictologist, neurologist, and an epileptologist. This list seemed to grow mostly because of my bipolar medication side effects, the peculiarities of my flavor of mental illness itself, and a tendency for one physician specialist to recommend yet another (usually a friend or colleague).

I happen to have the type of insurance that allows me to see specialists without primary doctor referrals. Yes, I suppose that does seem like a good feature, but then again, maybe not completely in all cases. The more experts I had seen, the more tests I had to undergo, and more questions arose. Yes, some of the test results yielded some answers, but I’d also found out I usually had to come back, frequently for more tests. I’ve also learned not all doctors communicate effectively with my GP, if at all. So, I decided to take a full responsibility for updating others and in detail on the vicissitudes of my condition. Today, I finally shared information I learned from all these various specialists with my GP, who in turn made it clear that he could handle many aspects of my case. Most of the issues in my medical history were not beyond his level of expertise. I’m not saying specialists aren’t the best choice for some problems, but more often than not, one good chat with your family doctor is worth thousand MRIs.

Moreover, unless you yourself communicate fully with your general practitioner, there is probably no one doctor who really knows your full medical situation. Yes, I have always supplied each doctor with my extensive medication list, but I think there is great merit to having one doctor overseeing the whole picture, especially in this day when many patients only get five minutes of a specialist’s time.

Right now, I only see my GP once a year for my physical, unless I become sick or hurt myself to a degree not severe enough for the ER. By cutting out some of these additional doctors, I wonder if it would be best for me to see him more than once each year. When I saw the nephrologist every five or six months (for about five minutes each time) he ordered the same exact tests that my general practitioner does, yet didn’t give me as complete of an examination. When my GP assured me that nothing in my test results was to be overly concerned about, I guess I almost felt a little duped. I certainly realized I had spent a lot of money on co-pays to specialists.

I’ve known my GP for about 16 years now, but it took until this week for him to convey that he needs to know everything that is going on with my health. I guess it’ll take a little effort, but I’m going to make a list of all my medical issues and bring it to my annual physicals. I won’t leave anything out. I also want to make sure I have all the pertinent information with me, next time I visit a specialist. And I’ll definitely keep my GP in the loop about those.

Do you have a long list of physician specialists you see? If so, have you ever asked your general practitioner if all were necessary?

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