Specialty Consults and Types of Doctors
Comprehensive Diagnostic Evaluations at J. Flowers Health Institute
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Specialty consults allow a primary care physician to get information from specialists to improve the care of the patient. One of the main issues with specialty consults is communication, reporting, and coordination of care. This article will discuss the issues raised by specialty consults and how J. Flowers Health Institute’s multidisciplinary team and comprehensive diagnostic evaluations minimize or eliminate these issues.
Learn how an accomplished team of medical professionals in the same practice can improve care and provide better treatment outcomes.
Types of Doctors
A patient’s primary care physician is responsible for a patient’s overall care. These types of doctors are usually known as general practitioners, family care physicians, or internists. GP types of doctors treat patients for everyday kinds of illnesses and conditions, such as colds and viral infections. This type of doctor also oversees a person's overall health and wellness with the use of yearly physicals, blood laboratory reports, and by creating full health histories.
Importantly, a general doctor also helps in the coordination of care and refers patients to specialist types of doctors when needed. The GP will get reports and information from the specialist to add to the patient’s full health history. This helps a GP coordinate the overall care of a patient.
Specialist vs. Primary Care
A medical doctor can be either a primary care provider (PCP) or a specialist. Specialists are types of doctors that have advanced education and training in a particular field of medicine. Although they are generally classified differently, every kind of doctor has a unique and important role in caring for the patient.
After graduating from medical school, a physician must complete a training period called a residency. This training takes place in a hospital and can take between five and seven years. The amount of time in residency will depend upon the specialty the doctor wants to enter.
There are primary care specialties, which include family practice physicians. Internists are primary care physicians who can sub-specialize in areas such as gastroenterology or cardiology. An internist usually has more training in a hospital setting than a family doctor.
There are many medical specialties for many different types of doctors. Comprehensive medical evaluations will use many of the specialists to improve patient care. Having multiple specialists in one medical practice enhances communication between the different types of doctors and leads to better patient care.
Types of Specialists
There are hundreds of medical specialties and sub-specialties available when searching for types of doctors. Some of the most common types of doctors an individual might visit include the following:
Allergists treat immune disorders, such as eczema and allergies to foods or other substances.
Anesthesiologists numb pain during surgery or other procedures.
Cardiologists specialize in heart and blood vessel issues.
Colon and rectal surgeons treat issues within the small intestine and colon.
Dermatologists handle problems to do with the skin, hair, and nails.
Endocrinologists treat hormonal and metabolic conditions, such as diabetes and thyroid issues.
Family Physicians can treat children, adults, and older populations.
Gastroenterologists specialize in the digestive organs.
Hematologists treat issues involving the blood, spleen, and lymph glands.
Internists care for and treat adults. They usually have extra training in sub-specialties and can help diagnose conditions or refer the patient to specialists.
Neurologists treat brain, nerve, and spinal conditions.
Osteopaths are fully licensed medical doctors that take a "whole body" approach to treatment. They believe in using modern technology while also trusting in the body's natural healing abilities.
Psychiatrists help those who suffer from mental, emotional, and addictive disorders.
These are just a few of the areas in which different types of doctors can specialize.
An addiction specialist is either a medical doctor or a psychiatrist who specializes in treating patients with substance use disorders. These doctors are specialists that are board-certified in addiction medicine by the American Board of Preventive Medicine and other relevant boards. They are very knowledgeable in the prevention, screening, intervention, and treatment of substance abuse and addiction.3 An addiction specialist can also help the family members of someone who is suffering from a substance use disorder.
When a general doctor realizes that a patient's condition requires the help of a specialty doctor, he or she will refer and set up a consultation for the patient.4 The PCP will continue to work with the specialist to provide comprehensive care efficiently. The doctors should share opinions and their knowledge about the best ways to provide care.
A specialist consultation can be a meeting between a doctor and a patient. It can also be a meeting or discussion that takes place between a patient's various healthcare providers.
The doctor ordering the consult will give the specialist a background on the patient’s health, care, and current symptoms. Generally, a specialist will examine the patient to see what tests or treatments they might recommend. The coordination of information between the two types of doctors allows each of them to provide better care to the patient.
What Your Doctor Should Consider Before Requesting Specialty Consults
Why is the Specialty Consult Needed?
There are three main types of specialty consults:5
- Advice on a diagnosis
- Advice on ways to manage a disease
- Making arrangements for a certain test or procedure
What Should be Done Before Specialty Consults?
The referring doctor should research the problem to provide the specialist with the best information possible. The research should allow the referring doctor to learn the most common types of information that the specialist may require during the consultation. The referring doctor should provide as much of this information as possible.
Some practices use referral templates to make sure the doctor performing the specialty consult has all the needed information. These templates can be created by the referring practice, or by the specialist’s practice. The goal of a template is to standardize data and to eliminate missing information that can delay the specialty consult, or make the consult less effective.
What is the Clinical Question to be Answered?
The referring doctor should clearly state the clinical question that the specialist is trying to answer. The referring doctor should be specific in what sort of answer or information they are looking for and should provide the specialist with context as to how the consult will improve patient outcomes.
What Information Will the Specialist Request?
A referring doctor should anticipate what a specialist will request. This might involve performing tests that are available at the referring doctor’s practice or ordering tests from other providers that can’t be completed by the referring doctor or the specialist. This part of the process will also require the referring doctor to organize the patient’s chart and medical history into a format that allows them to answer any questions the specialist may have quickly.
How Urgent is the Specialty Consult?
The referring doctor must decide how urgent the specialty consult is. If it is an emergency, the specialist will need to make room in their schedule to see the patient immediately. If the consult is urgent, the specialist will clear their schedule of matters deemed less critical to get the patient in as soon as possible. If the specialty consult is elective, it will likely be scheduled further out to make room on the schedule for emergency and urgent consults.
Does the Consult Need to Be in Person?
The referring doctor will also need to decide if the specialist needs to see the patient in-person or consider if a remote consultation or curbside consult will suffice.
There is a growing trend to expand access to specialists through telehealth programs. In fact, Congress is considering the Specialty Treatment Access and Referrals (STAR) Act to support the creation of a new telehealth infrastructure. The STAR Act was introduced by Representative Josh Harder. Congressman Harder stated that
“the technology and systems already exist in some places to connect doctors and patients . . . this bill would . . . lower [the] costs.”
Congressman Don Young stated
“[i]n our rapidly changing world, technology has evolved significantly, and health care delivery should be advancing along with it,” “Rural communities . . . can greatly benefit from increased access to telehealth services, and we should be supporting this technology to help expand to patients across the country. I am proud to cosponsor the STAR Act to work toward bringing down health care costs and delivering . . . personalized, patient-centered care.”
Jana Katz-Bell, Assistant Dean, Interprofessional Programs, University of California, Davis believes
“[p]roviding technical assistance support for health centers to incorporate eConsults into their daily operations is critical to reaching underserved communities and supporting specialty care[.]”
The COVID-19 crisis will also expand access to telehealth out of necessity.
How Should a Doctor Educate the Patient on Specialty Consults?
Explain the Reason for Specialty Consults
A referring doctor should explain the reason for the specialty consult without using medical jargon that the patient might not understand. There should be plenty of time for questions and answers. At the end of the explanation, the referring doctor should reinforce the name of the specialist and restate the reason for the consultation.
Involve the Patient in Choosing the Specialty Doctor
The referring doctor should ask if the patient has any experience with the specialist or the specialty field. It’s at this time that the doctor and patient should discuss gender preferences, language issues, and if the patient needs any specific location or hours.
Clarify How the Appointment Will be Made
Who will make the appointment? The referring doctor, or the patient. The doctor should explain to the patient how long the appointment should take to schedule and provide the patient with the specialist's contact information. It’s best practice for a doctor to let the patient know what staff members are available to help with any scheduling problems.
Discuss Potential Barriers
The doctor and patient should discuss common barriers to an effective specialty consult. These could include transportation, finances, or the patient’s need for a medical advocate. The doctor should work with the patient to overcome any barriers that are identified.
Document Meetings About Specialty Consults in Writing
State of the purpose
Advise for non-visit options
Provide scheduling details
Explain what the patient should do prior to the consult
Provide information about how the referring doctor will be involved after the consult
Provide all important contact information
J. Flowers Health Institute’s Treatment Advantages
As the preceding paragraphs show, the main issue with specialty consults is effective communication between doctors and the coordination of a patient’s care. Most of the clinical and scientific studies about specialty consults involve ways to improve communication and outcome.
The processes that are most often studies are referral templates and educating primary care physicians on how consultations should be made. Many of the best practices discussed above are taught to primary care physicians with continuing education and seminars. Referral templates are most often provided by specialists to make sure they get the exact information they need.
This focus on communication and coordination between practices misses one crucial fact. A dedicated team of specialists in one practice avoids most of the issues that people are trying to reduce with procedures and technology. This is one of the critical differences between J. Flowers Health Institute and other providers. Not only do we have many specialists under one roof, but all those specialists also share the desire to be a cohesive multidisciplinary team. It’s this focus and passion that allows J. Flowers Health Institute to provide unmatched comprehensive diagnostic evaluations that provide the best care for our patients.
Specialty Consults for Addiction and Co-Occurring Disorders
More than 20 million people in America who are over the age of 12 suffer from some form of substance use disorder. According to a survey conducted by the Substance Abuse and Mental Health Services Administration, 9.2 million adults in America suffered from a substance use disorder and mental illness simultaneously in 2018. .5
When an individual has a mental health issue and suffers from a substance use disorder at the same time, this is known as having a co-occurring disorder or a dual diagnosis.
For those suffering from a co-occurring disorder or have received a dual diagnosis, it helps to know that there are different types of doctors of varying medical specialties who are available.
Either a mental health illness or a substance use issue may develop first. In some cases, those who experience mental health problems may begin using drugs or alcohol to self-medicate and mask symptoms to feel better. Using substances, however, typically worsens the symptoms associated with mental illness.
In other instances, someone who is suffering from a severe addiction to substances may develop mental illness due to the drugs' effects on the brain.
Your Addiction Care Team
An addiction care team of medical specialists is key to total recovery, especially if the patient is suffering from more than one type of addiction or have a dual diagnosis.
The types of doctors that may be involved in your care include:
Psychiatrists who specialize in treatment for addiction
Medical doctors with expertise in withdrawal treatment
Psychologists and therapists who treat addiction issues
Registered nurses whose specialty is substance use treatment
Licensed addiction counselors
Licensed clinical social workers specializing in addiction
Occupational or physical therapists
A Multidisciplinary Approach
A multidisciplinary approach to rehab is vital because each person in recovery is unique in the types of help they need depending upon the substances being used and the mental disorder they may be suffering from.
A selective team of medical specialists will work closely with the patient and their family to develop a personalized plan of care that will likely include:
Medications to help with withdrawal symptoms and/or mental health disturbances
Spiritual and wellness care
Continued care planning
Disorders That Commonly Coincide With Addiction
Many people who suffer from substance use disorder also have a co-occurring mental health disorder. This is called a dual diagnosis.
When an individual receives a dual diagnosis, they need to have both disorders fully addressed to live a healthy, fulfilling lifestyle. There are some common mental and behavioral health conditions that are often linked to substance abuse. They include:
Attention-Deficit Hyperactive Disorder (ADHD): Someone with ADHD may abuse substances in an effort to manage their symptoms. Doctors might prescribe stimulants to help control ADHD symptoms, but these drugs can become habit-forming, leading to addiction.
Borderline Personality Disorder: People with BPD have a higher tendency to abuse substances because of their impulsive behaviors and emotional instability.
Depression: About one-third of adults suffering from depression also have a substance use disorder.
Generalized Anxiety Disorders: People who have GAD may tend to use substances like alcohol and drugs to relieve their symptoms.
Obsessive-Compulsive Disorder: Someone with OCD has compulsions and obsessions that are irrational. They tend to suffer from anxiety and depression, which may lead to substance abuse.
Post-Traumatic Stress Disorder: The brain of a person suffering from PTSD produces less feel-good endorphins. This can cause them to use drugs or alcohol in an attempt to feel happier.
Substance Abuse Can Cause Medical Conditions
The abuse of substances can lead to co-occurring medical illnesses. Gastrointestinal problems can occur due to the use of certain substances. Someone who abuses cocaine, for instance, can develop complications such as gastric ulcers and some serious gastrointestinal disorders.7
An addiction to alcohol can cause reflux esophagitis and disorders of the liver or pancreas. Those suffering from substance use disorders have a nine times greater risk for congestive heart failure, twelve times greater risk for liver cirrhosis, and twelve times the risk for developing pneumonia.8
Any of these illnesses require the help of a specialty doctor in addition to an addiction specialist.
Treatment for Dual Diagnosis
There is a wide range of mental health disorders, and everyone can be affected differently. A complicated relationship exists between an individual's mental health and having a substance use disorder. Those who are seeking treatment for addiction and a mental health disorder may have been diagnosed with a mood disorder, an anxiety disorder, a personality disorder, or an eating disorder.
The most common types of mood disorders include major depression, bipolar disorder, seasonal affective disorder, and substance-induced mood disorder.
With a substance-induced mood disorder, an individual shows symptoms of depression due to the effects of alcoholism or drug abuse in addition to the effects of other types of medications or toxins.
Some of the symptoms of mood disorders include:
Feeling sad or anxious for long periods of time
Having hopeless or helpless feelings
Feeling worthless and/or guilty
Having suicidal thoughts
Trouble with sleep
Decrease in energy
Inability to make decisions
Physical aches and pains
Sensitivity to failure or rejection
With a mood disorder, these symptoms do not come and go, but they continue over time and begin to interfere with their daily life.9
A psychiatrist or mental health professional can diagnose a mood disorder. Treatment can include antidepressants or mood-stabilizing agents, psychotherapy, family therapy, and other add-on therapies as needed.
There are five major types of anxiety disorder:
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Social phobia
Indiviuals who suffer from GAD are worried and anxious about any number of things continually. This anxiety interferes greatly with their everyday life. It causes sleep problems, restlessness, fatigue, irritability, and muscle tension.
Those who suffer from phobia disorders like OCD and social phobia are excessively worried or anxious about particular objects or situations. They avoid these things, take active steps to do something about them (such as washing hands over and over to avoid germs), or endure them with a lot of anxiety involved.
The primary symptoms of panic disorder are panic attacks. These are episodes of intense fear that come on quickly and might be triggered by a specific object or situation. The symptoms include heart palpitations, sweating, trembling, shortness of breath, and feelings of being out of control.
The types of treatment for anxiety disorders include psychotherapy, cognitive behavioral therapy, medication to relieve symptoms, support groups, and stress management techniques.
These types of disorders include borderline personality disorders and antisocial disorders.
An individual who has borderline personality disorder (BPD) has difficulty regulating their emotions. They feel things more intensely than other people do, and these emotions last for longer periods of time than usual. Following a triggering event, someone with BPD finds it takes a long time to return to feeling themselves once again.
Someone with BPD can have a distorted self-image, experience wild mood swings, have paranoid feelings, and feelings of depression. Treatment includes individual psychotherapy, dialectical behavior therapy, support groups, medications, and possibly short-term hospitalization.
Some types of this mental disorder include anorexia nervosa and bulimia nervosa. Eating disorders most often affect women between the ages of 12 and 35.10
An individual suffering from anorexia nervosa severely limits their food intake, has a fear of becoming overweight, and has a very poor body image. Their weight is generally 15 percent less than what their healthy body weight should be for their height. This disorder can lead to thinning of the bones, muscle atrophy, anemia, depression, and a decrease in blood pressure.
Someone with bulimia may secretly binge eat a lot of food very quickly, then vomit or take a laxative to be rid of the food eaten. The effects of bulimia can include an inflamed throat, swollen salivary glands, worn tooth enamel, gastrointestinal reflux disorder, kidney problems, and dehydration.
The treatments for eating disorders include psychotherapy to get at the underlying emotional issues that cause this behavior, in addition to nutritional counseling.
Overcoming a substance use disorder and a co-occurring mental health issue will require assistance from a team of healthcare providers. These types of doctors and other professionals will come together to consult one another on an ongoing basis concerning individualized care, especially when the patient enters a rehab facility.
Getting treatment as an in-patient or outpatient at a rehab center provides the care needed from an assortment of specialty doctors and addiction team members. There is help available to assist in overcoming both an addiction to substances and a co-occurring mental health disorder at the same time.