My Approach to Second Opinions

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I have numerous posts within this blog cautioning against pursuing second medical opinions.  This can be a tough argument to make as most patients  believe that obtaining additional medical advice is all upside. What could go wrong?  They argue that a second opinion either confirms the existing medical advice or provides new & improved recommendations.  It's not that simple.

If readers enter second opinion in the search function of this blog, you will find several posts that point out potential pitfalls of seeking medical advice from new doctors.  It's not all upside.

How do I regard my role when offering a second opinion?

I generally regard my second opinion role to offer general advice and explanations of their care and treatment.  Often these patients have been under the care of a gastroenterologist and other professionals for months or even years.  To suggest that I could step in and change the course of treatment after a 30-minute visit is arrogant.  I often do not have all of the facts or records.  A chart review, assuming that I even have the relevant records available, is no substitute for months of face-to-face care with numerous office visit conversations as well as discussions with colleagues.  You cannot discern the treating physician's instincts, impressions and clinical nuances from the record.  There may be a very good reason why a particular treatment was either recommended or bypassed.  And, the version of events as related to me by the patient, who is likely dissatisfied, may not be fully accurate or complete. 

Use caution when considering a second opinion

So, I inform these patients that I will be offering general comments but that they should return to their existing medical team for continued care.  I do my best to bring value to them during these appointments.  If I think that there is a new angle to be considered, then I suggest that the patient discuss this option with the doctor of record.

There have been occasions when I have seen a second opinion visit from a patient who likes his doctor and actually has an appointment scheduled with the physician in the weeks ahead.  He is seeing me simply because he wanted to be seen by someone sooner.  This does not seem to me to be an appropriate use of a second opinion function or of my time.  If you think you should be seen sooner, then call your doctor’s office and ask for this. 

Yes, there have been times when I’ve taken the patient on or have made more pointed medical recommendations.  But I generally refer the patient back to the doctors who have been deeply involved in their joint medical journey.

Who's to say that a second opinion is better than the first one?  Medicine is an art. A patient could see 5 doctors and be offered 5 different opinions all of which may be reasonable.  The patient may end up much more bewildered than before.