When Should I Get a Second Opinion?

 Now that I am employed by a colossal medical center whose reach extends internationally, many patients land on my schedule seeking a 2^nd, 3^rd or even a 4^th opinion on recalcitrant and unexplained digestive issues. Many of these patients travel from neighboring states coming with the hope that yet another gastroenterologist will crack the code of their illness.  Obviously, any patient who seeks another medical opinion is already dissatisfied, hence the reason for seeking additional advice..  Here is a sampling of some reasons why patients solicit or are sent for new medical opinions.

• Persistent symptoms
• Search for an explanatory diagnosis for unexplained symptoms.
• Quality check to verify that the original doctor’s advice is correct.
• Encouragement of family or close friends to seek another opinion.
• Dissatisfaction with the doctor’s bedside manner.
• Friction with the office staff or the billing personnel.
• Office schedule of original doctor is booked out for months.
• Fear that a serious diagnosis has been missed.
• Wanting to be told that they are not crazy.

Sometimes, obtaining a new medical opinion is an excellent idea.  But second opinions can also confuse and bewilder rather than clarify a medical situation – a point not appreciated by most patients and families.  Remember that medicine is an art where excellent physicians evaluating identical medical circumstances might offer different advice.  In medical conferences that occur every day throughout the country, medical luminaries discussing a case may have wildly different views on how to proceed.  So, when your 2^nd opinion doctor offers new advice, it may not be better advice, it may just be different.  Both sets of advice may be rationale and defensible.   I recognize that when different advice is suggested, it reinforces to the patient the wisdom of having sought a new opinion.  “I knew my first doctor was wrong.  The new doctor suggested something entirely different!”   Keep in mind that a 2^nd opinion physician also knows the patient was unhappy with the first doctor’s advice making it more likely that a new path forward will be suggested.  Will the new route truly lead the patient forward?  Hard to say.

The Second Opinion World May Leave You Lost.

Is it possible that several capable specialists have missed a diagnosis?  Of course, but it is unlikely.  Medicine never reaches 100% certainty.  How much testing would you consent to or pay for a few additional percentage points of certainty? 

If I am the 3^rd or 4^th opinion on a patient who has been thoroughly and repeated evaluated, should I simply pile on more testing?  Doctors can always find another test or two that wasn’t done.  Or, should we counsel these patients that it does not appear that the specialty of gastroenterology holds the solution to their frustrating quagmire.  How many months or years should any of us proceed in the same direction without making progress?  For many of these patients, choosing a new direction makes more sense to me.  There is a huge reservoir of healing pathways available ranging from conventional medicine to complimentary medicine with much in between.  While I may not know the precise pathway to recommend, I try to open the patient and myself to new possibilities.  This conversation  requires a very openminded patient.

If the direction you're traveling never reaches the destination, isn't it time to try a different route?