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At present, getting a second opinion has become
a common practice among doctors; in fact, the American
Medical Association advises that 'physicians should
seek consultation upon request; and in doubtful
or difficult cases'. That is why family physicians
often consult with specialists, and specialists,
in turn, consult other specialists - and superspecialists.
(Sometimes, though, the process could be misused,
and the patient may feel that he is stuck on a non-stop
merry-go-round of consulting a wide variety of specialists!)
Often, many patients tend to become sceptical or
dissatisfied if their doctor suggests that they
seek a second opinion, because they feel that such
a suggestion indicates that their doctor is not
competent. However, one should not forget that medicine
is a highly complex science in which rapid advances
are the order of the day and it is not humanly possible
for one doctor to keep abreast of all developments
in all fields. Consequently, a second opinion proves
very useful for those patients afflicted with rare
or complex problems. Unfortunately, some doctors
tend to refer patients unnecessarily to other members
of their fraternity. Also, doctors will often cross
refer patients to each other for personal financial
gain. In hospitals, especially, specialist consultation
is often automatic and mandatory, and this process
is inevitably overused. The upshot is that the patients
bill shoots up! Thus, a hospitalized patient should
ask the family physician (who should act as your
medical manager) to intervene if the number of specialists
involved in the treatment seems excessive.
It may be difficult to get an unbiased opinion from
a second doctor who is a member of the staff in
the same hospital as your doctor. If at all possible,
you should consult an independent doctor in another
hospital for a second opinion. Most medical insurance
policies that cover consultation fees will pay for
this. In case of disagreement between two specialists,
a third opinion could prove helpful. In the present
age of the telecommunication revolution, the 'magic'
of telemedicine enables one to get a second opinion
from a leading medical authority in any part of
the world. The procedure usually consists of sending
such an authority your clinical findings and medical
reports through the Internet, so that you can get
an unbiased opinion usually in as short a period
as two days. Many clinics in India now offer this
service in collaboration with leading hospitals
from all over the world.
I always encourage my patients to get a second opinion.
As I explain to them: If two different doctors happen
to reach the same conclusion, at least you know
you are on the right track! However, don't always
assume that just because the opinions of both doctors
are identical, you are safe . For example, if you
have angina and you consult a cardiac surgeon, there
is a high likelihood that he will advise you to
undergo bypass surgery. A second cardiac surgeon
is also likely to recommend the same; after all,
it's just simple financial common sense from the
surgeons' viewpoint! Therefore, getting a second
opinion from a non-surgical specialist (in this
case, a cardiologist) can be helpful in preventing
unnecessary surgery.
What course of action should the patient adopt
if the second opinion differs from the first?
Such a situation can be very confusing. Consequently,
the patient needs to do a good deal more homework
before making a decision. It would be worthwhile
to get a family physician (preferably one who
has no vested interest in the matter) to advise
you. It would also be prudent to discuss the differences
in the two opinions with the concerned doctors,
so that they can explain and justify the reasons
for the discrepancies in their diagnoses or plan
of treatment. Remember that it's your body which
has to bear the consequences and you need to make
your own decisions intelligently. It would be
highly sensible to ascertain your options in advance,
rather than to burn your fingers and then regret
your actions later on !
Many patients also worry about getting a second
opinion on their own accord. For one, they are apprehensive
that if their first doctor were to find out that
they have gone in for a second opinion, he may be
offended. Another source of anxiety is the confusion
that would result if they get differing opinions;
they are worried they would not know what to do
when confronted with such a situation. Most patients
are quite passive and they tacitly feel that it
much easier to trust their doctor and do whatever
he suggests, rather than go through the trouble
of getting a second opinion.
However, by getting a second opinion, patients should
realize that they are not casting aspersions on
a doctor's competence or judgment, but are rather
adopting a responsible attitude towards their own
health and well-being. All patients have a right
to seek a second opinion, and certain circumstances
may arise in which it would be appropriate, if not
mandatory, for them to exercise this right.
They can even ask the doctor (whom they are consulting)
himself to refer them to a second or even a third
doctor for further consultation. No competent doctor
will feel threatened if a patient wants a second
opinion ! However, many doctors in India do have
reservations about referring a patient seeking a
second opinion to someone else, as they are worried
that the new consultant may 'snatch' their patient
away. To solve this problem, some countries abroad
have set up specialized second opinion clinics ,
which consist of senior experts who have retired
from active practice, but who use their experience
wisely to provide unbiased second opinions ! Many
doctors are happy to refer their patients to such
clinics, because they are confident that they will
not lose their patients in the process !
Keeping all the foregoing factors in mind, the question
then arises: From whom should you get a second opinion?
You should seek a second opinion from an expert
who has the courage to give you an unbiased independent
conclusion. Such an expert would, obviously be difficult
to find, but it's well worth searching for him!
Another crucial question is: Should you let the
expert know your first doctor's opinion ? Many patients
do not tell the specialist that they have already
consulted another doctor, because they want an unbiased
opinion. However, most doctors do not appreciate
patients who play games with them. It's far better
to be forthright and explain to the expert that
you are looking for a second opinion, so that he
can explain the pros and cons of all the available
options.
An excellent source for getting an objective second
opinion is the medical faculty of public hospitals
- government or municipal. This source, unfortunately,
has been grossly underused. The staff members here
are basically academicians. Since they teach medical
students and residents, they are usually well read
and well informed. Moreover, since they do not have
a financial stake in providing you with advice,
their information is likely to be reliable and accurate.
Of course, this procedure does involve the bother
of waiting for a long time to get to see the doctor,
but this wait is often well worth the effort!
Remember that it is also possible to get a second
opinion from a doctor who practises alternative
medicine , for example, homoeopathy or ayurveda.
Such an opinion will provide a completely different
perspective of looking at a problem, and you may
prefer this alternative.
You should also keep in mind that there are other
ways of getting a 'second opinion' apart from going
to another doctor. Presently, many sources of information
can be tapped to verify and countercheck your doctor's
opinion; for instance, health books and encyclopaedias
(all of which are available free at the Health Education
Library for People, Bombay) as well as the Internet!
For example, you can "Ask the Doctor"
at www.flora.org/ask-doctor/,
a free site which forwards your medical queries
to specialists from all over the world, who then
give their respective opinions on your problem.
An important point to be noted is that a second
opinion should be sought under certain circumstances:
- If surgery is recommended. About 80 per cent
of all surgery is elective (i.e., performed
on a non-emergency basis). Recent studies have
shown that one out of five operations is not
really required -- what is considered 'unnecessary
surgery.' A second opinion can definitely prevent
you from becoming an unsuspecting victim of
an overenthusiastic surgeon's knife!
- If the diagnosis reveals a rare, potentially
fatal, or disabling disease. The original diagnosis
could be incorrect and may need to be revised.
Or, even if it is correct, there may be new
or experimental treatments available at an institution
specializing in the treatment of such a disease.
- If your symptoms persist unrelieved and the
doctor can provide no satisfactory explanation
for them.
- If the risks and benefits of the proposed
procedures are not satisfactorily explained.
The patient has a right to know the details
about risks and the cost involved and the potential
benefits of any procedure, test or surgery.
It is preferable to get the relevant details
in writing, so that you can digest them at leisure.
- If the diagnostic procedures seem unnecessarily
complex or expensive, or both. Some doctors
are prone to making excessive use of technology
in borderline situations, either due to insecurity
or to protect themselves against malpractice
litigation.
- If the patient lacks confidence in the doctor's
ability to do all that can reasonably be done.
Effective treatment demands trust, and a lack
of trust is as valid a reason as any other for
getting a second opinion.
Remember you have only one life, and you may not
get a second chance to rectify a medical mishap.
Many patients (or their relatives) who are victims
of adverse medical outcomes, later regret not consulting
another doctor, but by then the damage has already
been done! The best method is to avoid a problem
in the first place - by getting a second opinion
!
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