Primary Care Doctors Refer to Specialists For Specific Reasons

Dear Dr. Roach: When my primary doctor refers me to a specialist, does he have a responsibility to inform me of the various options and procedures? I have found, after doing my own research, that there were far better options available to me than just the specialist my doctor sent me to. This has happened to me on at least two occasions.

An example is when I was referred to a local brain surgeon to have a tumor removed. After some research, my wife found that a procedure was available using gamma knife. The gamma knife procedure was not available locally but was the procedure we decided on. This procedure was done more than 13 years ago, and I am doing fine. Shouldn’t my primary doctor inform me about the different options, or does he feel that he needs to refer me to someone locally? — T.L.

Answer: Referrals by primary-care doctors to specialists are made usually for one of two reasons. One is that the primary doctor desires additional expertise in diagnosing the condition. In this case, the primary doctor has to decide what kind of problem it might be, what organ system is involved, in order to find an appropriate specialist to help. Your primary doctor should be looking for an expert diagnostician.

The second is because the specialist has the ability to provide a treatment not available to the primary doctor, such as surgery or radiation. This assumes your doctor knows the diagnosis.

In both cases, your doctor ideally involves you in the discussion. He or she may know several different experts and may choose the most expert, somebody local and immediately available, or one whose personality and manner might work best with you. The primary doctor may lack the expertise to review the treatment options; in fact, that may be the primary reason for the consultation.

The specialist, on the other hand, certainly should have all the options for treatment in mind when discussing them with the patient and family. I was taught in medical school and still firmly believe that the doctor is obliged to provide the information necessary for the patient to make the best decision for him- or herself, even if it isn’t what the doctor thinks is best. In your case, that would include surgery (possibly several approaches), radiation (including gamma knife), medication and doing nothing.

Circling back to your primary doctor with your experience with a specialist can only help your doctor learn more about the specialist and know better whom to refer to that specialist.

Dear Dr. Roach: Do you believe that lycopene, which is found in certain foods such as cooked tomatoes, can help prevent prostate cancer? — C.R.O.

Answer: Lycopene, a vitamin A-like substance found in tomatoes and watermelons, was indeed thought to help prevent prostate cancer. Unfortunately, further studies failed to support this.

What has been shown more substantially is that a diet of fresh fruits and vegetables helps reduce risk for and even helps treat prostate (and other) cancer. So it may be that lycopene by itself isn’t enough, but that all the different healthy substances found in fruits and vegetables are. This diet certainly reduces risk of heart disease as well.

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