Should I Get a Second Opinion?

In the medical profession, there is often more than one correct answer. Present the same case to 10 seasoned medical practitioners and you will likely hear numerous rational plans of action. This scenario would be bewildering to patients and their families and is one reason that I have warned patients of the hazards of pursuing a second opinion.

Medicine is not mathematics where there is a single correct answer that can be proved.

Medicine is not like math.

How does a patient reconcile divergent recommendations offered by medical professionals?

Should a formal debate competition be held before patients and their families?

How does the medical team reconcile our differing views amongst ourselves?

Can we expect ordinary patients and their families to decide if surgery, medication or watchful waiting is the best option?

Despite the current culture of patient autonomy, shouldn’t it be the physicians’ task to direct patients toward what we believe is their best option? (I can’t count how many times patients have told me, “you’re the doctor; just tell me what I should do?”

Should physicians eschew the paternalistic approach suggested above, and simply present medical options and allow patients to make their selections in accordance with their own preferences, personality style, personal treatment goals and cultural and religious beliefs? Shared decision making is today's model.

These are vexing issues for all of us, especially in a profession where several ‘correct answers’ can coexist. There have been many times that I have counseled surgery, but the patient declined this recommendation. Each of us may have been 'correct'. Perhaps, this patient is elderly and simply utilizes a medical playbook that is different from her younger physician. Perhaps, she endured a terrible complication from surgery performed in the past. Or, perhaps, she wants to try to wait it out, a strategy that is often successful in the medical world.

The only thing that physicians are 100% certain of is our uncertainty. Our best advice may be dead wrong. Conversely, mediocre medical advice may deliver the desired outcome. The medical universe is a murky and mysterious entity for those who visit it seeking answers. Even those of us who call it home grapple every day with its vagaries.

My advice? Be aware as you enter the labyrinth that you are no longer in the world of algebra and geometry. Don’t try to pursue the single best option, which may not exist. Choose, with your physician’s help, a path that makes sense for both of you.

Comments

Becoming a Part-Time Physician

Next month my schedule will change. I will henceforth be off on Fridays with my work week truncated to Monday through Thursday. I am excited to be enjoying a long weekend every weekend. And while the schedule change is relatively minor, this event does feel like an important career moment for me. It is the first step on a journey that will ultimately lead beyond my professional career. It is this recognition that makes this modest schedule modification more significant than one would think it deserves. As some readers know, my current employed position has been a dream job for me. Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally. My partner and I ran the business. Working nights, weekends and holidays were routine for decades. On an on-call night, if I slept through until morning, I felt as if I had won the lottery. And w...

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term. Years ago, I never received such inquiries. Why now? Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area? Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring. “Interesting,” I remarked. Since I was unaware of this retirement news, I asked her when would be my last day at work. I have no idea where this erroneous rumor originated from. I requested that my nurse-friend contact her flawed intel source and set him or her straight. Retirement might seem tempting to me as I have so many other interests. Indeed, reading and ...

Will Smarter Lawyers End Frivolous Lawsuits?

How do you know if a lawyer is any good? Of course, they've all passed the bar, but now their profession is lowering it. While most of us strive for excellence, and raise our children to value this virtue, prominent legal educators are establishing a new quality intitiative for their profession. Who says that lawyers can't reform themselves? Perhaps, we physicians can follow their bold example and raise the credentials of our pre-medical students. I’ll present the facts. You be the judge. I have written a dozen posts on tort reform on this blog, which always generate spirited and adversarial retorts from attorneys and their supporters. They accuse me and other tort reform advocates of carrying water for insurance companies. They repeatedly point out that I know nothing about the legal system and are unqualified to opine on its flaws. They deride me when I argue that effective tort reform would reduce the practice of defensive medicine, despite the re...

MD Whistleblower

Search This Blog