How do patients know whether to see my family physician vs when to got to a specialist? it seems unclear.

Many specialist : Prefer a referral and refuse to see patients not referred, but others accept self referral. I always want a primary care doctor to follow issues that I am not going to manage, and keep the pcp fully apprised of what and why I do things or recommend things.

Step by Step: Primary care physicians are there to help you sort through issues so that you get the help you need, and so there's continuity even when you might also need specialty care. If you use your family doctor as your medical home base, s/he can keep up with all the specialty exams and tests, along with you. S/he can care for you in most areas, and suggest specialists as needed. Simpler for all.