Though primary care physicians and nurse practitioners are intended to be patients' first point of entry into the health care system, approximately seven out of 10 people in U.S. commercial health plans (and 95% of the elderly) see one or more specialists a year.
Although managed care plans originally intended to control visits to specialists - and some still require a referral from the primary provider - for the most part, if you need a specialist, you can see one.
When you do see a specialist, it's important to know how to interact with them to make the visit more effective and helpful.
While these physicians are highly trained, they focus on a specific area of the body, and that area is their primary focus when examining and treating you. Since we all 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 you may be managing.
Before the visit
Thus, make several considerations before visiting a specialist:
1. Know what you want.
Before seeing a specialist, ask yourself: 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?
2. Do your homework.
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.
3. Review your insurance.
Before even making an appointment, it's best to know if insurance will cover the visit, if a referral or preauthorization is needed, and what documentation you'll need in the event of a claims dispute. It's also key to know the financial differences between visiting an in-network versus out-of-network provider.
4. Be sure everyone is on the same page.
Know beforehand how your primary care provider will communicate relevant information to the specialist and vice versa.
Ensure all communication is in writing and includes a review of your medical history, current medications, the reason for the referral and all relevant diagnostic testing results.
5. Time the appointment appropriately.
If your primary care provider's office sets up the appointment with the specialist, make sure you're comfortable with the amount of time between the visit and a follow-up appointment with your primary care provider.
To get an expedited appointment, it usually is more effective to have your provider's office call and make the request.
6. Have a plan in place.
When you have any interaction with a health care provider, being prepared helps reduce fear and anxiety and allows 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 manage the meeting (see "A sample agenda," left.)
After you see the specialist, what next? Confirm whether you'll have a follow-up visit with your primary care provider to discuss the specialist's treatment recommendations.
Contributing Editor Betty Long is a registered nurse and founder of Guardian Nurses Healthcare Advocates, a healthcare advocacy firm that has helped thousands of patients navigate the health care system and saved millions of dollars in health care costs.
A sample agenda
While it may seem awkward at first, employees should consider creating an agenda before their visit with a specialist. Here's a sample agenda for a patient visiting an endocrinologist to help manage her diabetes:
Objective
To seek an expert opinion on the management of my diabetes care.
Discussion topics
1. Why I selected you as my diabetes specialist.
2. 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?
3. 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.
4. 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.
5. Preventive care. Am I doing all I can to prevent complications of this disease?
6. 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?
7. Healthcare goals. How do I continue to educate myself about my disease?
Additional questions
* Plan of action/next steps
If you are having trouble developing an agenda, ask your primary care provider for help.
