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Tuesday Jul 28, 2020

Your Patient Wants a Second Opinion? It's Not Personal

I've always believed that I am secure enough in my medical knowledge base that when a patient asks if I would mind them getting a second opinion, I would encourage them to do so, so we could make an informed decision on how to move forward with the co-management of their illness.

[second opinion illustration]

Sometimes patients feel afraid to broach this topic because they don't want to offend me. Patients who make such requests rarely intend to consult another primary care physician. Usually, they want to speak to a subspecialist.

I was reminded of this recently when I, as a patient, went to see a subspecialist. I was uncomfortable with the recommendations made by this doctor. Luckily (or not), I have several physicians and other health care workers in my family, so, as the recommendations were made, I texted them to my brother, a physician who lived in another area and had privileges at another health care system. He in turn shared the information with a colleague.

The physician at the second institution thought there was an alternative diagnosis and management strategy. I spoke to my own family doctor, and she supported the second opinion.

I felt guilty about making the first physician feel like I did not trust the medical advice being given, but I wanted to make sure I was doing the right thing. I almost didn't go for a second evaluation; it was just the manner in which the first physician was so adamant about me following instructions. (I later reviewed my patient portal and saw a note that described me as unreasonable and noncompliant.)

Of course, the second subspecialist could have come to the same conclusion and advised the same treatment plan, but there would be no downside to confirming the first physician's opinion. I wanted to know all my options. Ultimately, the second physician made a different, correct diagnosis and treatment plan.

I was fortunate not only to get a good second opinion but also to have good health insurance that covered that vital second visit. I wonder about those who are less fortunate and have less access, and those without a family physician to rally and support their need for more information.

I also was fortunate that my situation was urgent but not emergent, and I understand there are urgent situations where it may not be possible to get a second opinion expeditiously.

Later, I contacted the original physician to follow up about the second, correct diagnosis and treatment plan. That first doctor thanked me for the information. (No, I didn't bring up the patient portal notes about my noncompliance.)

This experience reminds me to be humble and to not take it personally when a patient asks for a second opinion. It is what we would do for our loved ones.

To err is human. And we are all human.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is a member of the AAFP Board of Directors.

Posted at 04:22PM Jul 28, 2020 by Tochi Iroku-Malize, M.D., M.P.H., M.B.A.

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