I am always surprised when supposedly good doctors don't refer to a specialist if they encounter a problem for which they don't have an answer. i think one of the signs of an excellent doctor is when he or she says, "I 'm not sure what this means" or "This is something that needs further investigation by a specialist." Of course, in the HMOs, referrals cost a doctor money because the referral dollars are taken from his or her paycheck. How any doctor can allow this to influence a decision about a patient is beyond my comprehension.
I was talking recently to a woman in her late seventies who just had a complete physical. She was pleased that the doctor spend almost an hour with her which is unusual because the woman belongs to an HMO and the doctor is a G.P. The woman mentioned that the doctor found no feeling in her feet and that this was an on-going problem. The M.D. didn't seem bothered by the finding but did get a blood sugar to look for diabetes. "Didn't he refer you to a neurologist", I asked? "No", she said. I was appalled. Numbness of the feet could mean several things but certainly a neurologist should see the woman and at a minimum do nerve conduction times. If this doctor doesn't have an answer then hopefully a neurosurgeon or orthopedic surgeon will be consulted to see if the numbness is due to nerve compression since the patient has had two bad back injuries because of being rear-ended.