Navigating Healthcare VII: Chefs in the Kitchen

Too Many Cooks in the Kitchen: The Challenge of Multiple Medical Opinions

One of the most complex challenges in healthcare today is navigating the abundance of medical opinions. As a primary care provider, I often find myself weighing how much guidance to offer when a patient is already under the care of a consultant. The primary purpose of a referral is to ask a focused question and seek an expert opinion. In procedural specialties—like surgery—I’m often simply requesting that a task be performed. But with diagnostic referrals, the situation becomes more complicated.

A recurring issue is what I call consultation creep—when a specialist refers the patient to yet another specialist, expanding the medical team beyond what’s necessary. While more opinions can provide a broader perspective, they can also introduce confusion, especially when those opinions conflict.

Who Should the Patient Trust?

When faced with competing recommendations, patients are often left wondering: Do I trust my primary care provider or the specialist? Add to that the voices of friends, family, and the ever-present Dr. Google, and it’s no wonder patients feel overwhelmed. The internet has made everyone a "health expert," regardless of actual training or experience.

What’s more concerning is a growing distrust in traditional institutions and subject matter experts. Increasingly, patients turn to influencers with no clinical background, drawn to their charisma rather than their credentials. These individuals may "look the part," but often lack the depth of knowledge necessary to provide sound advice.

Balancing Expertise and Holistic Care

As someone who has worked on both sides—specialist and primary care—I understand the value of targeted expertise and the importance of seeing the bigger picture. Specialists often anchor strongly to their area of focus, while primary care providers are expected to synthesize recommendations within the broader context of the patient’s life.

Patients, too, bring their own biases. Some arrive with a firm belief in a self-diagnosis sourced from Google, even when the actual likelihood of that condition is statistically low. Others trust their primary care provider so much that they dismiss a subspecialist’s insights altogether. This is the clinical version of "too many cooks in the kitchen."

Moving Beyond the Paternalistic Model

Historically, medicine followed a paternalistic model: "Do what I say, and don’t ask questions." But modern patients are more informed, more vocal, and more empowered to participate in their care. In many cases—especially with rare diseases—patients become experts in their own conditions, sometimes knowing more than the providers treating them.

Patients often have a mix of biological, psychological, social, and spiritual needs—yet most providers are only trained to address a fraction of these dimensions. As a result, we may miss the complexities of a patient’s decision-making process, especially if we overlook factors like cost, education level, or cultural context.

Two Frameworks: Blame the Patient or Reflect as a Provider

When a treatment plan fails, we have two choices: blame the patient, or examine our own approach. It takes humility to ask whether our plan was realistic given the patient’s life circumstances. Labeling a patient as “non-compliant” is often a reflection of a failure in communication or empathy.

A Better Way: Consult Smarter, Not More

One potential solution is rethinking how we access specialty input. Virtual consults—where a primary care provider presents the case and receives feedback without the patient being seen in person—can reduce unnecessary appointments and testing while still accessing expert guidance. This model minimizes anchoring bias and preserves continuity of care.

Specialists, like primary care providers, face time constraints. They may order an excessive number of labs to compensate for limited time with the patient, often resulting in more confusion than clarity. Every lab and appointment adds cost, complexity, and potential stress.

The Patient Should Remain the Focus

Specialists are important. Primary care providers are important. But the patient is the most important person in the healthcare system. Ideally, every provider acts as a team member working collaboratively to develop the best possible plan for the patient’s unique situation.

However, reality often looks different. Just as patients accumulate medications over time, they often accumulate specialists—sometimes without clear benefit. Periodic reviews of both medications and medical teams are essential. Are all these specialists still necessary? Are they helping or complicating the picture?

The more providers involved, the greater the risk of missing the forest for the trees. The general rule still holds: as patients become healthier overall, many of their smaller issues tend to resolve on their own. That’s why simplifying care, reviewing ongoing needs, and eliminating redundancy can often lead to better outcomes—not just for the body, but for the whole person.