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Comment by ErikVandeWater | Hacker News Reader

> On top of that, most doctors only have a very narrow understanding of the human body and don't know when to refer you to some other doctor they will be better equipped to help you.

Are we talking about doctors, not nurse practitioners? It's hard to understand how a doctor with 4 years of medical school and 3-7 years of residency would have a "very narrow understanding" of the human body.

Also, my experience has been that I have always been referred to a specialist when there was any uncertainty about diagnosis or treatment. My trouble has come from them not following up when an RX is denied by insurance, and making it difficult to schedule a doctor's appointment due to not being able to transfer my previous information.

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Let me give you my own example:

I suffer from pretty debilitating fatigue. It started when I was 13 or so, which was also a few months after I suffered a bad concussion. I have low testosterone, and treating that helps some. Autoimmune diseases run in my family; my father has lupus, his siblings all have something, and I have a small patch of psoriasis on my head (to which my doctor said "huh.."). My white blood cell count is always moderately low, even after an infection. I get sick extremely easily and stay sick longer than other people. I frequently get chills in my limbs like a person does when they're sick, though the testosterone helps. The chills are a sure thing when I don't get enough sleep. I get cluster headaches, and recently I started getting really frequent eye twitches leading up to when the cluster of headaches start.

Who should I see to try and figure out the root cause of the fatigue? An endocrinologist? Urologist? Sleep doctor? Neurologist? Immunologist? Rheumatologist?

It's hard to know what's relevant to the fatigue. When I was first treated they simply put me on antidepressants. After giving up on those, years later I did some research and had to practically beg just to have my testosterone levels checked along with some other things that were fine.

Doctors are T-shaped [0] - a GP knows a little about a lot and most have an area of interest or two that they're really well-versed in. There's just too much complexity, even within a single system, to be an up-to-date expert on everything.

For instance I have an endocrinologist (at Stanford, not to name drop but to signal this person is really good even among doctors) who only deals with thyroid. I naively figured that an endocrinologist would deal with all kinds of hormone issues but no, she's thyroid and thyroid only -- she has a colleague for testosterone, another for diabetes, etc etc.

I don't know that I'd say GPs "don't know" when to refer you; GPs are gatekeepers who will try conventional solutions to conventional problems and generally unless you push won't often suggest going deeper with a specialist. It's not that they don't know to refer you, it's that they're Level 1 Tech Support for the body and often times unless you make a stink they won't connect you to Level 2.

[0] https://en.wikipedia.org/wiki/T-shaped_skills

The average PCP is usually also an internist, which is just a fancy term for someone who knows just enough to be able to send you to the right specialists. And since in the US many specialists require a referral, that's all most PCPs are good for.

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