A reader writes:
Primary care doctors don’t know all the resources for a given medical problem in their geographical area. They will tend to go to whomever is their acquaintance or on the staff of the hospital that they are on the staff of. I found that two of the leading surgeons in the country for a problem that I had were at the regional academic medical center, but my doctor recommended people at the local community hospital. I have since in discussion found that to be a common pattern.
It is true that I tend to refer to people I know. In my case, that tends to be the community specialists. I’ve met these physicians, talked with them, and read their consultant notes more frequently. I’m able to gauge patient satisfaction by asking how their experience was with a particular specialist.
I always give the option of going into Boston, or to a larger tertiary care center. The caveat is that I am not familiar with the specialists down there, so other than the reputation of the institution, I can’t give a more personal recommendation.
I try to present the pros and cons of both scenarios, but the ultimate choice is the patient’s.