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Generalist or specialist: which is better?

By on February 28, 2011

If you need to see a doctor, is it better in the first instance to consult a general practitioner (GP) or a specialist?

 

After all, a specialist knows more than a GP, right? 

 

Although in a narrow sense a specialist should know more than a GP, it is not necessarily better to go direct to a specialist, and it can be disadvantageous to do so.

 

The first problem is that the patient has to decide himself or herself which specialist to consult. For example, if you have a persistent headache, do you go to a neurologist, general physician (internist), ENT specialist, orthopaedic surgeon, or even a psychiatrist? All these areas of medical practice may be relevant to the symptom of persistent headache. If you go to a neurologist, he will likely carry out a brain scan and pronounce that there is nothing wrong. But apart from being reassured about the absence of a brain tumour a rare disorder the patient is no better off and then has to choose another specialist to consult.  

 

Here is an example from my experience. A young woman’s periods stop. She visits a gynaecologist who finds nothing wrong with her internal organs and prescribes hormones to restart her menstrual cycle. Unfortunately, he did not look above her waist and failed to realise she was suffering from anorexia nervosa, a psychological condition. This means time is wasted and she is given inappropriate treatment. 

 

A specialist will tend to do his specialist thing, which may not be necessary. For example, if someone is suffering from indigestion (dyspepsia, tummy pain related to eating) an experienced GP may well be able to deal with this with simple advice and treatment, whereas the gastroenterologist will likely do a stomach camera test (endoscopy) not the most pleasant thing to undergo. By visiting a GP first the patient may thus be spared the inconvenience, time, discomfort, and hazards of unnecessary investigations. Endoscopy is not a completely safe test. Similarly, exposure to radiation from X-rays and CT scans may be minimised or avoided. 

 

A general practitioner is a doctor who has been trained in a wide field of medical practice. This means that he or she can deal competently with the majority of patients’ problems and is able to recognise the more serious disorders requiring specialist attention. It is also important that the GP can refer the patient to the most appropriate specialist for the patient’s particular needs.

 

Dr Gabriel Symonds, a general practitioner, is the director of the Tokyo British Clinic (established 1992). He has wide experience in general and family medicine and is one of the few foreign doctors licensed to practice in Japan. 

www.tokyobritishclinic.com

Tel: (03) 5458-6099

About Dr. Gabriel Symonds

Dr. Gabriel Symonds was the director of the Tokyo British Clinic. The clinic closed down in May 2014 after serving the expatriate community for 20+ years. Dr. Symonds has retired and the Tokyo British Clinic is now closed. Dr Symonds will continue to live in Tokyo and may be contacted by e-mail over any questions concerning medical records or related matters: symonds@tokyobritishclinic.com He will be available from another address for: smoking cessation psychotherapy/counselling circumcision information Tel: (03) 5458-6099 www.tokyobritishclinic.com