A few months ago I talked about my Husband and his visit to the Doctor. https://wakinguponthewrongsideof50.wordpress.com/2022/06/15/the-doctor/. To summarize, I talked about my Husband needing a Doctor and running into finding a specialist who worked on exactly what my Husband’s injury was.

As always, the comments about this issue were great, but as I discussed this issue with people, once I got past the humor and ridiculousness about needing to find a sports medicine Doctor who specifically worked on calves, I begin to think about how we got to this point:

Have we become a society who specifically wants the BEST, and who will only accept the word of an EXPERT?

How many times in the past two and a half years have we heard the phrase: According to experts?

How many times have WE uttered the words: According to experts…?

Did I need to call six Doctors because as a society we demand people to be specialists? Do we want to be treated by someone whose title has the word “general” in it?

If you were going in for surgery, would you want to be treated by a general surgeon, or would you want one who only deals with exactly what you are going through, and only that? If you have breast cancer, do you want to be treated by the best “cancer” person, or by the best person who specifically treats the exact type of cancer that you have? You don’t have to actually answer in the comments, but be honest with yourself about this…

I must admit…if I was having surgery, I would listen to the advice of one of my friends who knows medical way better than me: Go with someone who has done a fellowship in exactly what you need done- they are the most qualified…

I now turn this discussion over to you: what do you think about the rise in specialists? Is there a real need, or have we forced the issue?

114 thoughts on “Have We Done This to Ourselves?”

  3. Personally, I prefer a specialist, especially if it is something major. I do feel there is a need for generalists as they have the education and know how for many specialties. For me though, I prefer to see a specialist when warranted.

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      1. Do you trust your PCP? If so, and unless they are getting a kickback for referrals, then when they suggest a specialist believe them. If they want you to have the best care there’s a reason they refer.

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      2. My pcp is HUGE on the specialists…he immediately refers me to one because he feels as a pcp he’s more like a diagnostician, and would prefer to have a specialist look at something. But I wonder if it’s too much reliance on them

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      7. I think you’ve pointed to a real issue with the current way medicine is practiced: is the job of any person in the medical field, a specialist or a generalist, to keep you healthy or to focus on fixing a specific problem you’ve brought up? If any physician one sees, even if it’s for a problem with one’s right pinkie toe, that the patient is jaundiced, is it ok for them to ignore it because the toe is fixed?

        If specialists feel it’s not their job to keep their patients healthy, they’re not very… “special”!

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      8. That’s well thought out…and you have a solid point- what’s the goal overall? My doctor says he’s quarterbacking all the specialists to make sure I’m completely healthy…but does that really work?

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      9. This is true and I wonder how often a specialist’s focus goes beyond their specific area of expertise. Do they have the expectation that the generalist will have caught any other issues. It’s interesting to contemplate if they have lost sight that they were once just a “regular old doctor” to begin with.

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      10. I think you’re right that there seems to be an issue with missing the forest (health) for the trees (treating conditions and issuing referrals…). It seems like they may all try to pass the hot potato… the generalist refers the patient to a specialist, and forgets about the patient. The specialist treats a very narrow condition, assuming someone will catch the hot potato of the whole.

        Maybe physicians should get get incentivized to keep us healthy, not to treat conditions and refer us to someone else? …

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      11. I also think some of the responsibility lies with the patient. I am a huge proponent of being informed and taking charge of one’s own health. Also having honest discussions with your PCP regarding tests, treatments, along with the alternatives. I taught pregnancy and childbirth education for many years. I saw women simply allowing their OB’s to make decisions. It was a struggle to help them understand that they had the right, and the responsibility to take charge of their own care.

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      13. Often it’s that they don’t care, but just as often it’s because they really don’t realize they have a say in their medical decisions and care. Most of the time anymore, as evidenced by this post, we have medical teams–patients have to be able to recognize and be encouraged to be a team member as well, and sadly they often are not. There are informed consumers in all areas, and then there are those (for all sorts of social reasons) that have no clue they have patient (consumer) rights.

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      17. I love that. I think we need much more of that: of education for the “every day patient.” I once saw stats about how many hysterectomies are medically unnecessary. To my shame, I don’t remember the stats, just that they were shocking. If we had more folks like you educating more people in the “patient population”, I bet that wouldn’t happen. More of you, please!

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      20. I think this is an important question. There are few professions that introduce themselves as “Hi Deb, I’m Doctor LA”, immediately creating a hierarchy 🙂 Folks in the medical profession tend to communicate almost exclusively using obfuscated terminology. Add to that the when a patient normally encounters someone from the medical profession, they are already at their most vulnerable and weak, being sick/hurt/injured, and faced with an unknown financial burden on top of everything else. No, it doesn’t absolve the patient of all responsibility, but wouldn’t you expect a little more leniency towards the patient than in most cases?

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      21. I think part of the problem is the way you need to become a doctor…you have people who were high achieving students, with little room for interpersonal skills. They’re more automaton than anything else

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      22. I’m dealing with issues with my father in law (if you’re counting that’s 5 of 6 parents or their significant others who have had health issues in the past three months) my father in law has had various symptoms and I don’t think anyone is connecting the dots, plus my father in law is a horrible patient who misuses Google and determines what medicine he should or shouldn’t be taking without talking to his doctor…I foresee grief in my future

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      23. And these older than us folks are often distrustful plus being uninformed. It definitely adds to the issues, and yes- I would say get prepared for some battles all around.

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      24. He eats highly processed foods continually. Now he’s got swollen ankles. Won’t change his diet. Says he’s going to walk a mile a day to get rid of it. He also has super high numbers that shouldn’t be, and super low in other things, has eczema but no origin story and fatigue. But walking a mile a day is going to cure it all

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      25. These are the folks I personally believe you just have to let go down their own paths. The capacity for change is well beyond them at this point

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      29. Personally I think it is good for a Dr to refer you right away. I have been dealing with a bad knee since April. I found out a few weeks ago after I finally was allowed to see a specialist that I had a torn meniscus. Took 2 trips to my Dr and 2 trips to Urgent Care and also PT (that I couldn’t tolerate) before they decided to do an MRI and send me to a specialist. 😡. The rationale was I had atypical symptoms, was too active and no arthritis per X-ray so I did not warrant an MRI. Yet the specialist by palpation and exam immediately said he was sure it was my meniscus. So for me, had my Dr sent me to a specialist in April I would have had a much better summer! So I think your guy is doing the right thing!!!

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      30. I hear things like this and I’m team specialist. But like last year, I was sent to three specialists for a conclusion of migraines. All I thought was really…I needed six months and three appointments for that?

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  4. I see a “specialist” of sorts as my PCP- an internal medicine doc. I chose her because clearly I am done with childbearing and many of the associated needs, as well as now being of an age that I want to focus on healthy aging and needs associated with that realm. I always took my kids to a generalist rather than a peds doc, but if they had developed an issue very specific to children I wouldn’t have hesitated to seek out a peds specialist. I remember chuckling about your post and the “calf doctor” thinking that may be a bit extreme, but then I realized how glad I was that we found a specific ankle orthopedist to repair my daughters shattered ankle…Long story short- there’s a place for everyone to use their skills on whatever level those may be. I don’t think the public has forced it, I think it was a natural evolution of the profession. There are specialists within many, many career fields.

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  5. From another perspective, as a former nurse, I see physicians referring people to specialist because they are afraid of lawsuits. I think, in one way we have tied the hands of the general practitioner and the general surgeon to look after the population.

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    1. Oh that’s a really good statement…I think you make a great point…sort of pass the buck, but you can’t really say anything because it’s for the good of your health

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  6. When dealing with medical people at a certain point you have to trust your intuition. It’s not like there’s a Yahtzee score card that you can use to decide precisely who’s the winner. It’s just a roll of the dice.

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  7. Having a GP who can identify when you need a specialist is also key. One reason people are living longer is that we have so many specialists. Medicine has come a long way in the last few decades.
    The thing is, when you have a life threatening medical problem you want a doctor who specializes in your specific area of need. l see a gynecological oncologist for my ovarian cancer. But my GP, actually his nurse practitioner, recommended I see a gynecological oncologist. What was thought originally to be diverticulitis turned out to be something more. And I sure would rather have a specialist operate on me, wouldn’t you? But even as an expert in his field, my oncologist called in an another expert while I was in surgery. My cancer had spread to my intestines (which my doctor anticipated) so he had a surgeon on hand who specialized in that particular field. He came in and removed part of my colon. So while my oncologist is an expert in his field, he still called in someone else who was a specialist in an area he wasn’t. Im sure my doctor could do any kind of surgery. But he called in another specialist for the colon. And I’m glad he did. That way, when I woke up even though I many Bodily parts and tumors removed, I didn’t have to live with tubes everywhere etc. specialists know what they are doing. I was relieved that I “functioned normally” because specialists did my surgery. I’m grateful for those doctors.

    In college you learn from experts who specialize in their areas of expertise. As an elementary school teacher I taught all the subjects. But, my specialty areas were reading and language arts. When the states started breaking down subject areas for state testing and imposed sophisticated skills to be mastered by 4th graders in writing, my administrators had me teaching just writing so our school could have the highest writing scores in the state. (We consistently were number one or two). But I had to insist I teach reading along with writing because they go hand and hand. Without reading good novels/short stories, poetry etc. you can’t give students a full understanding of great writing if they’ve never experienced reading it. Anyway, what I’m saying is… I could teach pretty much anything. But administrators quickly realized that my students year to year constantly scored higher in reading and language arts than other students. So they used me where they thought I’d be most effective. Personally I missed teaching social studies, but I was so happy when I didn’t have to teach math anymore. Lol Everyone has their specialty areas.

    Anyhow… a good doctor is a good doctor. But I think you hire a specialist for whatever you are doing. If I want a floor installed I don’t hire my AC guy. He might be able to do it but I’d prefer the person who knows more about floors. For colds, however, I’ll take good old Marcus Welbey. ( I’m not sure your readers are old enough to understand that reference ).

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    1. James Brolin on a motorcycle….but yeah…part of me wants the specialist, but part of me is like, if it’s routine, do I need a specialist…but how do you know it’s routine? So I flip flop

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      1. Ha! I forgot about Brolin. He was the young guy on that show. That’s right! Good memory!
        I don’t think a specialist is needed for everything. But when it is, it’s the best way to go.

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    1. To be fair, we have at least 4 teaching hospitals in Manhattan…so yes…we clearly have an abundance. But if you lived 100 miles away, is it worth it to travel to see a specialist?

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      1. Absolutely. When my MIL had cancer she was seeing an oncologist in Upper Michigan who suggested she get a second opinion from the specialists down in Milwaukee (which is where we need to drive to see experts). Although the specialist was 4 hours away from her doctor, the specialist advised her doctor the best and newest cutting edge course of treatment for the cancer she had. If it’s something rare or difficult, like a friend’s teenage daughter who has heart cancer, you pretty much go right to Milwaukee. But I think most people around here find a local specialist like an oncologist who treats cancer in general but not a specific kind. Plus it takes forever to get in to see specialists. I waited 4 months to see a doctor for my arthritis and they don’t even have a doctor in the area, they have doctors that rotate filling the position. And psychiatrists, don’t even get me started on that…very long waiting lists.

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  9. Interesting point. We moved away from some of the best medical facilities in the country for sanity, and peace. The availability of experts and top notch medical facilities was a consideration. As for focusing on “experts,” they are hit and miss. I focus now on experience.

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      2. Yes! My husband has his physical last week. It was actually performed by a resident. My husband hoped the doctor was listening and not wondering what’s for lunch

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      3. My wife had 3 hip ops. The third went really bad. The PA did the “close” and welp, she was on antibiotics for 3 months. Really 3 months. At one point they wanted to use a “wound vac” to help the incision close. The surgeon had 15 years experience….

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  10. Primary Care doctors tend to send you off to a specialist when something is out of their realm or comfort zone. If I’m having a knee replacement, I want someone who will do the best job. I ask for recommendations and talk to people before I make my final decision. If I don’t click with that doctor, I look for another – someone I feel comfortable with doing the surgery. Not to be crass, but I think there are more specialists because there is more money in specializing.

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    1. Not crass…realistic. A specialist is clearly going to be paid more…if I were a doctor, I’m pretty sure I’d want the paycheck that befits ten years plus of med school, residency and fellowships

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  11. We always ask our doctor friends for the best doctor for whatever surgery is needed. We didn’t have many general surgeons around us. Now we’re starting completely over in AZ. We can’t even find a primary! The Mayo Clinic has a three to four-year wait. And that’s the “BEST” place to find a doctor.

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  12. In many circles people in the US don’t have or can’t afford anything other than “general” for their pains. I think maybe this is a regional thing? But, I also believe that if we have the same level of access for everyone – no matter the income level – as they do here in The Netherlands there would be less of this discussion as the access to specific areas of medical attention are available (with referral) to EVERYONE!

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    1. I don’t want to get into nitty gritty, but for myriad reasons that are not only about the money, there is no way that government sponsored health insurance would ever work in America.

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      2. Social security was supposed to provide care for all those over 65. It doesn’t work. There’s a difference between looking at thing realistically and looking at the things with rose colored glasses. Instead of free healthcare for all, let’s see what can be managed. With a population the size of America, and with the diversity of the population, it’s not realistic. Add in Americans wanting to sue for everything. Then add it things like if the government pays, what is your right to service as a person. If they think there is a problem I. Utero, do you bring the child to term? Is the needs of the state greater than that if the individual. Do you treat people over the age of 65 if they have stage 3 cancer, because is it good for the state? Do you use a plastic surgeon to stitch the face of a kid who fell, or are the stitches provided by a generalist because it doesn’t matter? Will American women be ok with mammograms every other year, which is what I believe they do in Canada, or will they be ok not hearing whether or not they mammogram was ok like in England? Will there still be a divide because some can afford private healthcare, and the doctors with all the specialties will only do private healthcare patients? It’s easy to say we should do something but no one has an actual plan on how to accommodate this. No one wants to compromise about anything. So while there’s a divide as there is, yeah, you can’t try. But wait a few months to read my post about what’s going on in my neighborhood now. It will further explain the problems that we face are greater than oh…let’s give healthcare to everyone…

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      4. I didn’t expect you to change your mind. And trust me…this is the tip of the nit and the grit. I could write volumes about this. Remember I’m not a words girl…I’m a numbers girl who analyzed things and made a good living looking at things. You may not agree with what I say, but realize that I’ve thought about this both professionally and leisurely

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      5. Also we don’t have free health care we pay insurance each year that everyone in this country must have and then when everyone pays in everyone gets healthy havre when they need it. I have had more friends and family than I care to mention in the US that either can’t afford health insurance or wait until they are on deal that door to see a doctor because of the crazy expensive capitalistic system in American healthcare. Just saying, I see it a bit differently.

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      6. You’re allowed. But for every thing you see, think logically about the other side. No. What’s here isn’t great, but no one, and I mean no one has come up with a viable solution. Tske a good long look at malpractice. Take a look at lifestyle and diet of Americans.

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      7. I have agree on the American lifestyle and diet! But, we already have social health care and it is called the VA! I know how that system works and honestly I would rather have paid health insurance to get my care anywhere else. In a way… I did. I just feel badly for those don’t have the same options or opportunities that I have been granted.

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      8. If someone smokes, is told not to smoke, and gets all sorts of lung related disease…how much money to use to save him if he just continues smoking? My dad was denied stuff because he’s on Medicaid but they consider him too old. There’s too many people here. Name a country that has a population and diversity of America that has successful government sponsored healthcare

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  13. I go my GP, they refer me to hospital and stuff happens. I leave all the choices to them. Your system seems somewhat different, but this should be no surprise as Americans can’t even order a sandwich without micro-managing the ingredients.

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  14. It is interesting that the specialist field has evolved so much. I worked for 18 years in a medical office for a group of 7 doctors. While they were all internists, one had a specialty in cardiology, one in gastroenterology, one in infectious disease, one in nephrology. If a patient needed a referral it was done in-house. It was more convenient for the patient and the $$ was kept in the corporation. I do think the insurance issue makes an impact on specialists too. If a doctor feels they will make more money from the insurance co, they will go into a deeper specialty. I noticed after I left that there was some in-fighting in the group about who was getting credit for which patients and that was a total insurance issue.

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  15. As in many things, the answer is “it depends.” Some of the best doctors I have had looked at the whole picture and probably picked up on something a specialist might have missed. Without indulging in a 95 page essay, let me say that the current government medical “experts” have proven themselves to be corrupt as evidenced by their actions over the last several years and now are jumping ship before people find out just how bad it was. An “expert” is not always a good thing. Meanwhile, there were lots of good doctors out there treating patients successfully and vilified for it.

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  16. When I was nursing a baby I has a hard mass in one boob and I went to lactation consultants and my general practitioner, and I ended up with a large painful abscess that needed to be drained because an abscesses are rare so no one had the experience/expertise. If I had it to do over again I would advocate with my doc to refer me to a breast specialist. However, it takes a LONG time these days to get in with a specialist, at least in my area!

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  17. A great question. On the one hand, I get frustrated when I have some general issue, but I’m immediately referred to a specialist. However, if I’m facing something serious I would want the best of the best.

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      1. And we are moving away from doctors who understand the human body and have experience to more technology based medicine that uses data to diagnose. It doesn’t always get it right. It’s like we moved backwards in some ways.

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  20. I just thought of something else. When I am looking for a surgeon I want to know they have experience! If there is a general surgeon who has done lots of the specific surgery I need compared to a specialist who has only done a couple. If they both have good reviews I will go with the general surgeon.

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  22. I have no problems with specialists as long as that doesn’t mean the general public can’t find a doctor when they need one. And as for the idea of wanting to hear from the experts, I firmly believe that you can convince people of anything if you preface it with the words, “Experts say….” “Science says” works just as well.

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    2. Science, especially medical science, continues to advance at such a rapid pace that there’s no way any one person could keep up with it all! My kid has decided to be a GP which some have said is at the worst and lowest paying end of the spectrum of medical specializations available these days. She agreed but was good with her decision because it will allow her more regular hours and the ability to work more from home, where she’ll probably do research on her own to direct her patients to the proper specialist!

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  24. I’m particular. I want someone who knows what the hell they’re talking about and who to send me to if they can’t fix it and who also has a good bedside manner. I WANT IT ALL!!!!!!! Unfortunately, my insurance doesn’t pay for any of these things. Probably why I try to stay away from any doctor if I can help it. Does that make me a diva? Ha! Mona

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  25. Society has created a certain “image” when it comes to qualified people. When you say the word “expert” Most folks are imagining someone with a degree, schooling, an office etc. it’s honestly hard to tell because there are plenty of qualified practitioners out there with no schooling and there are some with schooling/training that have no idea what they’re doing. Really depends on the person, how passionate and knowledgeable they are about their craft.

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  26. There’s a reason why those folks have specialties, and it’s usually because they’ve studied/researched X topic for years.

    It’s the reason I take what my general practitioner says with a grain of salt. In my experience, they never really know what to tell you.

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      2. I think about last year…I went to vestibular rehab, and was sent to an ENT, audiologist, neurologist and vestibular neurologist. I had multiple scans with meant going to the scan place. And it took 9 months to find out I had a migraine episode. On one hand I appreciate ruling out really bad things. On the other hand…

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      3. Yeah, I hear you. I feel the same about this menopause stuff, which ironically, gynecologists don’t know much about, which has caused me to go to a different specialist for each issue :-/

        Maybe the GP should know more?

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