This wouldn’t be so confusing if I had thought about what specialists and general practitioners are each supposed to do. But I have no such a priori understanding. I send a patient to a specialist, and my thought is something like this:

“Gee, I hope they pursue a self-limited course of diagnosis and treatment based on the clinical question I have in mind!”

And the patient, on the other hand, thinks something like:

“Dr. Berger wants Dr. Gutskener to figure out why my belly hurts.”

Dr. Gutskener, on the other hand, possesses a treasure of expertise around the gastrointestinal tract, and doesn’t generally feel his role to be limited in the sense Dr. Berger (me) is thinking of. He takes “limited” to mean “within a given subspecialty” – he does GI, not neurology or cardiology. But within GI, he is taking care of the patient referred to him as best he knows how, and that does not mean a minimal approach.

Graphic by Dave Gray

At some point, telling a specialist not to further test and treat a patient is like Ronald Reagan trying to recall a missile that has already been launched by submarine. But I have had patients where I would like to email the specialist and say, politely, Stop!