Why patients with non-specific symptoms get bounced between specialists—and how to stop it
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Patients with vague, non-specific, or medically unexplained symptoms often move from specialist to specialist because modern medicine is organized around organ systems and pattern recognition.
—David Cutler, MD
[Patients] can get caught in that network of being passed around without actually having a primary care physician who is organizing everything.
—William Schaffner, MD
A patient presents with non-specific symptoms. What do you do next?
Managing patients with non-specific symptoms is a challenge facing specialists across medicine, and it can lead to a high amount of referrals.
“You will have earnest physicians trying to address a patient's problem, and frequently not being able to put their finger on what the diagnosis is. So they begin to get referred to specialists who might do some more elaborate testing, and they can get caught in that network of being passed around without actually having a primary care physician who is organizing everything and who is there as the central person providing reassurance and care to that person,” William Schaffner, MD, an infectious disease physician at Vanderbilt University, tells MDLinx.
Part of the problem with patients being bounced between specialists, some experts argue, is the structure of modern day medicine.
“Patients with vague, non-specific, or medically unexplained symptoms often move from specialist to specialist because modern medicine is organized around organ systems and pattern recognition. When symptoms cannot be attributed to a single organ or do not fit a clear pattern, several forces can push patients into prolonged diagnostic journeys,” David Cutler, MD, board-certified family medicine physician with Providence Saint John’s Physician Partners in Santa Monica, California, tells MDLinx.
"A cardiologist looks primarily for cardiac explanations, a gastroenterologist for GI causes, a neurologist for neurologic disease, and so on," Dr. Cutler says. "If each evaluation is negative within that specialty’s domain, the patient is referred onward rather than integrated into a unified explanation. This is why it is so important to have a generalist primary care physician."
The consequences of fragmented care
Steven Vasilev, MD, is a gynecologic oncologist specializing in endometriosis, and founder of the Lotus Endometriosis Institute in Santa Monica, California.
He has seen the result of years of disconnected care among his patients with endometriosis.
“For excision surgeons, a substantial proportion of referrals arrive after years of fragmented care with incomplete workups, no assessment of central sensitization or pelvic floor dysfunction, and unrealistic expectations that surgery alone will resolve all pain,” he tells MDLinx.
He maintains that this could be avoided if more physicians were aware of ACOG guidelines.
“The single most impactful change would be widespread adoption of ACOG's 2026 recommendation[] that a symptom-based clinical diagnosis is sufficient to initiate empiric hormonal treatment. This eliminates the significant delay in obtaining relief from life-altering pain. Augmented pelvic ultrasound (including the sliding sign maneuver) has 88% sensitivity for deep endometriosis and should be performed before referral to help triage patients who truly need urgent surgical evaluation from those who can be at least temporized medically,” he says.
Reducing unnecessary referrals
Fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome, and long COVID are just some of the many conditions that present with non-specific symptoms that can lead to frustration among patients and an excessive amount of referrals between providers.
Laleh Gharahbaghian, MD, clinical professor of emergency medicine at Stanford, says there are a number of things physicians can do to reduce unnecessary referrals between specialists.
“Open and honest discussion with the patient for specialty limitation awareness, expectation setting, shared decision making, and goal setting will help. A team-based approach, when the primary care doctor and specialists discuss a challenging case together, is ideal for next steps, if possible, although [it] may be challenging if the various doctors are not part of the same health system. This keeps everyone in the loop,” she tells MDLinx.
“Some conditions have guidelines on their diagnosis and management, but most of the time multiple referrals are made due to reaching the limit of those guidelines and needing to seek expertise/additional insights from others.”