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July 26, 2006


Question from West Jordan, Utah, USA:

I have type 2 diabetes. I have seen my regular doctor and I have seen a diabetes educator, but I want to see other people. What do you think?


By other people, do you mean an endocrinologist? There are some philosophical issues and there are practical issues. First, the philosophical. I believe everyone has a choice to see a physician of their choosing. You are not obligated to see only a given physician when it comes to your health. If you have a good relationship with your primary physician, you may want to tell him or her why you would like to see someone else. This happens all the time. Of course, you want additional product as a result of this interaction. You may be wanting additional expertise, time with the physician, or the comfort of a second opinion. When I talk with large groups of people when this comes up (I am an endocrinologist), I tell patients that there are only enough endocrinologists to see roughly 15% of all the patients with diabetes. Primary care physicians in a variety of areas (Internal Medicine, Family Medicine, and OB/GYN) see the majority of the patients. However, if your outcomes are not good, as represented by the A1c, you do not have access to someone with expertise in diabetes, or, if you have special needs, these are all reasons to see a specialist. Very often what can happen is that you can see the specialist along with your primary care physician so that you have the benefit of both physicians. You just do not see the specialist as often as you would if you didn’t have your primary physician working with you.

The practical issues are bit more difficult. Insurance plans can tell you whether your health insurance policy gives you the choice to see a specialist. If you can, this is not an issue. If you have to be referred by your physician, than you will have to communicate with them as to why you would like to. If you both disagree, there is usually a way to handle this through the insurance company.