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Is Seeing a Specialist Always Best?

When people ask me about finding a doctor, I almost invariably tell them to see a headache specialist. Seeing someone with headache-specific knowledge is important because headache disorder education isn’t widespread. But is seeing a specialist always the best idea?

Dr. Aniruddha Malpani of The Patient’s Doctor writes:

Most patients want to go to the doctor who has special expertise in handling their particular problem. They will spend a lot of time and energy tracking down the “biggest name in the field” – and then leave everything up to the doctor. This can often be a short-sighted approach, because specialists are biased, and it’s important to be aware of this bias.

While it’s true that an expert has a lot of experience in dealing with a particular problem, this extensive experience also introduces all sorts of bias in the way he handles this particular problem. There are many reasons for this.

Because he is used to seeing complex cases which have been referred to him, he often cannot deal with simple bread and butter problems ! He also sees life through a distorted lens, and may not be able to see the big picture. Because he cannot afford to make mistakes, he often overtests and overtreats. He often asks for esoteric and expensive (and painful) tests, to differentiate himself from the other ordinary doctors. He also usually bad-mouths alternative options of dealing with the problem – after all, this is his competition! He is reluctant to refer cases which he cannot handle, because this would damage his aura of omnipotence and omniscience.

Often, in the pursuit of narrow goals, he loses objectivity; and is more interested in doing research rather than treating patients. Many experts are so used to seeing only sick patients, that they often cannot recognize a normal variant!

What do you think? Let us know in the comments below or on the online support group and forum.

4 Responses to Is Seeing a Specialist Always Best?

  1. Sue says:

    Interesting. I just returned from seeing a headache specialist out of town. There is no question that he has a certain bias toward treatment options, but they seem to make sense in terms of my previous attempts at treatment and management. It didn’t feel “generic” at all.

    The doc spent a FULL HOUR with me discussing my case and everything I had already tried, was interested in trying, or had never heard of. He was VERY thorough in his neuro exam and his questioning.

    And he listened.

    The truth is, my family doc has as many (if not more) biases regarding headache treatment. The difference is that the specialist took a real interest in my case, and took the time to personalize my treatment options. He left open the possibility that if done of Plans A, B, or C worked, I could return for further visits.

    It was a very positive visit.

  2. KC says:

    I just recently started seeing a neurologist who is a headache specialist. He is FAR better than the primary care doc or “regular” neurologist I was seeing. He actually knows what he’s doing!!! He hasn’t ordered any further tests since the “regular” neurologist had an MRI done about 6 months ago. Just going on my experience, go with the specialist!

  3. Heather says:

    I have suffered with chronic migraines for a while (14 years) but they have really been out of control, affecting my daily life for 3 years or so. Part of the reason for that is the Topamax I was taking for them has stopped working. My normal neurologist has not had ANY answers…so I have made an appt. with a headache specialist in two months. (It takes a while to get in.) I am hopeful that the specialist will look at me with a “clean slate” and really work to address my headaches.

  4. kate says:

    I say go with a headache specialist, but I also say that not all specialists are created equal. I had a FABULOUS and totally helpful one for about five years, before he closed his practice. He was totally current, open minded, respectful. Also – was MUCH more knowledgeable than a general neuro or g.p. Before and after him, I had headache specialists who were not nearly as good, or just a bad fit. I saw one who did not even ask about my history, – just looked at my list of meds and began telling me what I should change. Very condescending and arrogant – dumped him fast. I’m just saying, even at that level, you can still shop around for a good one, and may need to.

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