Chapter 18: A Second Opinion: A Prime Necessity
|Who shall decide when doctors disagree?
- Alexander Pope
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, dont 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, its 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 its 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 doctors 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 its well worth searching for him! Another crucial question is: Should you let the expert know your first doctors 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. Its 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 doctors 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:
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 !