Is a specialist needed?

If your loved one has a skin problem, you might suggest they call a dermatologist. For their hurt ankle, you might look for an orthopedist. However, their primary care provider (PCP) should be your go-to resource. The PCP can guide you to any other needed healthcare, including a specialist who treats specific illnesses or parts of the body. This helps make sure that doctors are working together to give your loved one high-quality care that’s right for their medical history.

Start with the PCP 

For medical care that isn’t an emergency, start with your loved one’s PCP.

“Primary care providers are trained to take care of common things uncommonly well,” explains Matthew Collins, M.D., M.B.A., executive vice president and chief medical officer at BCBSRI. “They know the patient, their history, and their wishes for your health. Patients should always seek their advice about care and keep them informed about medical needs.”

PCPs may be able to treat problems themselves rather than sending your loved one to a specialist. That can save time and money. This is especially true if your loved one has a chronic but manageable condition such as diabetes or asthma. “Patients should reasonably expect to be able to get regular care for these types of conditions from their PCP,” Dr. Collins says.

If the PCP recommends seeing a specialist, ask for one in the network of your loved one’s health plan. (Some plans require a referral from a PCP, so be sure to check first.) If your loved one belongs to an Advance Primary Care^SM practice, you know they’ll be referred to a specialist that offers high-quality, cost-effective care. For more information on Advance Primary Care, please see the information later in this article.

What to ask 

When seeing a specialist, your loved one should ask all of the questions listed below.

• Do you have a lot of experience treating patients with conditions like mine?
• Which hospitals can you admit to? If surgery is involved, ask about the hospital where the specialist wants to perform the operation.
• Do I really need surgery/tests or is there something else I can do to help the problem (for example, exercises at home)?

“I encourage patients to bring written questions to their appointment. I set aside time for them to ask their questions during a visit,” says Dr. Mazza. “Communication is a two-way street and one of the most important parts of the patient-doctor relationship.”