Primary care or a specialist: who should you see first?

When something's wrong, it's tempting to go straight to a specialist — the heart doctor for chest twinges, the dermatologist for a strange mole. Sometimes that's exactly right. Often, starting with primary care saves you time, money, and a couple of unnecessary appointments.

What primary care is for

A primary care provider — a family medicine doctor, an internist, a pediatrician, or frequently a nurse practitioner or physician assistant — is your medical home base. They handle preventive care, common illnesses, ongoing conditions like high blood pressure or diabetes, and the first look at almost any new problem. Just as important, they know your full history, so they can connect dots a specialist seeing you cold would miss.

When to go straight to a specialist

Some situations call for a specialist from the start: an ongoing relationship with a known condition (a cardiologist when you already have heart disease), a clearly specialized need (an orthopedic surgeon for a torn ligament), or anything your primary care provider has already referred you for. If you've got a standing specialist for a chronic issue, you don't need to route every related concern through primary care first.

The referral question

Whether you need a referral is an insurance question, not a medical one. Many HMO plans require a primary care referral before they'll cover a specialist; most PPO plans let you self-refer. Check your plan before booking a specialist directly, or you may end up paying out of pocket for a visit you assumed was covered.

A rule of thumb

New, undifferentiated, "I'm not even sure what this is" problems usually belong with primary care first. Known conditions, clear specialty needs, and anything you've been referred for can go straight to the specialist. When you're unsure, a quick call to your primary care office will point you the right way — and it's a lot cheaper than guessing wrong.