When Should Your Doctor Refer for a Second Opinion?

As a gastroenterologist (GI), I am regarded by primary care physicians and other medical professional as having special expertise in digestive diseases.  Indeed, I have highly specialized training in digestive maladies and function.  I regard myself as a GI generalist, that is a practitioner who treats the full array of digestive conditions.  Over the past decades, I have treated patients with diseases of the small and large bowel, stomach, and esophagus issues and pancreatic liver and gallbladder disorders.  And I have had a full endoscopy practice – the tools of the GI trade.  One of the appeals of being a GI Gen is that I see a wide and diverse span of medical conditions.  In a single week, I may address heartburn and ulcers. Crohn’s disease, hepatitis, bowel changes, internal bleeding, nausea and vomiting, abdominal pain, and hemorrhoids.  I enjoy the variety.  

GI Generalists Cover a Lot of Ground!

During most of my career, I seldom referred patients to other gastroenterologists for advice.  But, whenever I needed help, I asked for it. There were instances when I was unsure of a diagnosis or my proposed treatment was not effective.  If this occurred, and I harbored doubt or concern,  I arranged for another opinion.  Obviously, judgment and common sense must be relied upon in this process.  If I can’t explain a patient’s symptom that is clearly a benign issue, I may not advise another GI opinion to assess it, unless the patient requests it. General gastroenterologists see thousands of patients each year, yet only a small fraction of them are referred out for additional GI advice.  Knowing when to solicit another medical opinion is an important and necessary skill for every medical professional.

I now work for an internationally renowned medical organization that is based in Cleveland.  I’ll leave it to my reader-sleuths to divine its identity.  There are well over a hundred gastroenterologists on staff.  There are scores of GI generalists like me but also superspecialist GI’s who focus on very narrow niches within the specialty.  There are physicians who specialize in the esophagus or the pancreas or the liver, for example.  There are experts in celiac disease and gluten disorders.  There are doctors whose practices are devoted to various forms of colitis.  There are also physicians who spend most of their times performing futuristic and complex endoscopic procedures. 

How has this impacted me?  The availability of superspecialist GI talent means that with every patient I see, there are doctors on staff who are more knowledgeable and experienced than I am in addressing the medical issue.  This is a humbling realization.  Should I be referring every patient to the downtown experts changing my role from physician to a triage functionary?  Of course not.  In any profession or occupation, one can perform at a high level of excellence even if there are colleagues nearby who have stronger credentials.  Imagine if we insisted upon seeing the absolute best physician, electrician, attorney, house painter, accountant, pet groomer, hair stylist, teacher or photographer?  The system would collapse.  First of all, good luck agreeing on who is, in fact, the very best.  Secondly, when we hire a professional or a tradesman, we are seeking competence, fairness, and integrity all of which may be below the apex of the reputational pyramid.