Dear Dr. Gott: What education does a primary doctor have and what does he or she have for an education to be certified? Today, if I want to know anything about myself, I have to go to a hospital or specialist. Why is this?

It's very costly for me. I'm going on 89, and in my past life, my doctor could give me all the answers and help I needed. Things are expensive and scary.

Reply: Your question is an excellent one. I hope I can do it justice. A primary-care doctor in the United States goes through eight to 10 years of grammar school (pre-kindergarten to eighth grade), four years of high school, four years of college and four years of medical school.

A one-year period of training in a hospital setting under the supervision of attending physicians is known as an internship. During this period, an appreciable amount of time is also spent attending lectures and conferences.

A United States Medical Licensing Examination (USMLE) is then taken prior to applying for a residency programme in the United States. Most programs are between four and six years, depending on the field a future physician chooses to enter.

Thus, a minimum of 25 years is required before a person can be qualified as a practicing physician. This is a long-winded way of saying your former physician was well qualified to handle your case in a "one-stop shopping centre".

Medicine as we know it today is not what it was several years ago. To begin with, we relied extensively on a patient's verbal history, performed a hands-on examination of the body part in question, and did everything possible to bring relief as quickly as possible. I'm not implying we didn't have X-ray machines and laboratories. We had state-of-the-art equipment for the time and used it whenever necessary.

However, today, we have extremely sophisticated tools, access to superb specialists in almost every field and often demand a second opinion. Why? So we won't get sued!

Sadly, our country has turned into a sue-first, talk-later society. If anything goes wrong, blame the doctor. After all, it's his fault, isn't it?

He's the one first consulted. If we refer a sick person to the emergency room of our local hospital, we can share the blame.

If your primary-care physician is uncertain of a diagnosis or what to do next, he or she will do exactly what yours is attempting – share the burden of responsibility.

And it's an arduous, long and expensive process. Speak with your physician, explain your concerns, and ask whether he or she can work with you so you don't have to be referred out. At almost 89, you deserve to have your wishes honoured if possible.

Just be levelheaded so that if a medical situation truly calls for a specialist or hospital, you follow the advice of your doctor.

If your physician is unwilling, you are free to find another physician. Small-town physicians are a dying breed, but there are still some out there.

There are even some younger physicians who take issue with the way health care is moving into the future and want to get back to when patient care was more important than health-insurance payments.

To provide related information, I am sending you a copy of my Health Report 'Choosing a Physician'. Other readers who would like a copy should send a self-addressed stamped number 10 envelope and a cheque or money order for $2 to Newsletter, PO Box 167, Wickliffe, Ohio 44092. Be sure to mention the title.

Dr. Peter Gott is a retired physician and the author of 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook' Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.