If you have heartburn, you may be wondering whether you should ask your primary care physician (PCP) for help figuring out a treatment plan or if you should see a gastroenterologist, a doctor who specializes in gastrointestinal issues. To help you decide, we spoke to Samantha Nazareth, M.D., a gastroenterologist in New York City. Before booking your appointment, consider the following.
REASONS TO SEE A PRIMARY CARE PHYSICIAN FIRST
You need a referral to see a specialist. In short, you may not have a choice. Many health insurance companies require a referral before you can see a specialist or else they won't provide any coverage, so call your health insurance company to make sure you know what your policy rules are. If your health insurance company does require a referral first, call your PCP and ask what's needed to get one; you may need to schedule a visit with your PCP first.
Your PCP is the "quarterback" of your care. “They really are the hub of everything,” Dr. Nazareth says. If you've have a trusted PCP, this doctor has the best big-picture view of your health and understands the full spectrum of all of your medical conditions. Plus, they may be able to guide you to the best local specialist if necessary, so you're not stuck Googling or fishing for recommendations from friends.
You have an annual physical coming up. If your annual physical is approaching and your health insurance plan covers that regular visit for free, then there's no reason not to bring up your heartburn symptoms with your PCP at that appointment. It may save you time and money, since you won't need to schedule an additional visit.
Your heartburn is mild or moderate. If you’re interested in learning more about lifestyle changes, over-the-counter medications like Nexium 24HR, which provides all-day, all-night protection from frequent heartburn (aka you experience it two or more days per week), or prescription medications, either a PCP or a specialist can help. If your PCP isn’t sure about your diagnosis, they may send you to a gastroenterologist, who will have five to six more years of specialized education.
REASONS TO SEE A GASTROENTEROLOGIST FIRST
You don't need a referral to see a specialist. If your health insurance company doesn't require you to get a referral before seeing a specialist, you could find someone on your own and schedule an appointment. If you want to skip having to make an extra appointment with your PCP, be sure to update them at your next physical so they can keep track of what’s going on.
You don't have a good relationship with your PCP. Consider the following questions:
-Does your PCP listen when you speak and seem sympathetic?
-Do you trust their judgment?
-Have you been with them for a while and do they know you well?
-Do they take their time with you?
-Is it easy to make an appointment?
-Do they explain what your treatment options are and the risks/benefits of each?
-Do they seem knowledgeable about heartburn?
If the answer to a number of these questions is no, that's a good reason to seek out a gastroenterologist who may be a better fit for helping you with your heartburn.
Your heartburn is chronic or severe. As mentioned earlier, a primary care physician is limited in terms of what kind of care they can offer you for heartburn. “[The PCP will] take a history. They’ll say, ‘How long have you had this?’ etc.,” Dr. Nazareth says. “But what I’m looking for are complications and steps beyond that.” If lifestyle modifications or medications aren't sufficiently treating your heartburn, or if you have any unusual symptoms, then you may need a GI procedure like an endoscopy, and only gastroenterologists are board-certified when it comes to doing GI procedures. If you suspect that you'll need a specialist, you might want to seek one out directly from the get-go.
You have multiple medical conditions. Doctors are always pressed for time, so if you're dealing with several medical conditions simultaneously, it may be hard to squeeze in enough time to discuss heartburn with your PCP in a short visit. In that case, a gastroenterologist may be a better fit because you can focus on that single issue during your entire visit.
The bottom line: Check with your insurance to see if you have a choice. And if you do have a choice, you're fine either way. If a primary care physician can't treat you, they'll refer you to a specialist who can. Most importantly, “the patient should go wherever they feel comfortable,” Dr. Nazareth says.