I think of the terrible Primary Care Manager (PCM or PCP) we dealt with via Tricare Prime and military clinic in Fairfax, VA . . . and how she could not understand why he needed a MedicAlert bracelet . . . or a referral to an allergist.   

This, after child having been diagnosed 10 years earlier and having history of anaphylaxis and confirmed test and retest several times.

From that pub above:

Quote
Perceptions of Referral Physicians' Management of Anaphylaxis


Most allergists (57%) surveyed stated they believed primary care physicians (PCPs) were somewhat knowledgeable about anaphylaxis, 18% stated they are very knowledgeable or knowledgeable, and 26% stated they were not very or not at all knowledgeable about anaphylaxis.

The ACAAI allergists stated that, on average, nearly half (48%) their patients were referred to them after visiting an ED and being diagnosed with anaphylaxis, 45% had an allergic reaction before diagnosis, and 20% were misdiagnosed with any condition other than anaphylaxis. Fewer than one third the allergists (30%) believed ED physicians or PCPs accurately diagnosed anaphylaxis more than 50% of the time, 43% stated referring providers gave patients presenting with anaphylaxis a prescription for an epinephrine auto-injector, and 10% stated referring physicians provide the patient with directions on how to use the device more than 50% of the time.

Allergists' self-reported adherence to anaphylaxis practice parameters and perceived barriers to care: an American College of Allergy, Asthma, and Immunology member survey

Stanley Fineman, MD, MBA, Paul Dowling, MD, Dianne O'Rourke, MPAemail
Received: June 18, 2013; Received in revised form: August 29, 2013; Accepted: September 30, 2013;


Link to full text:

http://www.annallergy.org/article/S1081-1206(13)00734-5/fulltext