28 March, 2024

Second Opinion: Why, What, When, How?

Introduction:
Obtaining an expert opinion is an essential component of medical decision-making. Sometimes, even after an expert opinion, one may not get satisfactory information to make an informed decision. There can be many reasons for that.

While lack of expertise, trust, or empathy are valid reasons for being critical of a professional opinion, our biases or denial sometimes prevent us from believing in the initial diagnosis or treatment options.

For the discussion below, let us label the original professional opinion as ‘Physician A’ and the second as ‘Physician B’.

Why go for a second opinion?
The simple answer is “when you are still indecisive after a complete initial professional opinion.” There are certain elements to it.

*You may be satisfied with the decision Physician A made but want to cross-check the opinion provided by Physician B. This is a valid reason to pause and seek a second opinion. If it hurts Physician A’s feelings, then you should definitely seek a second opinion.

*If you believe physician A is going out of his professional boundaries (for example, a cardiologist opining about a bone fracture).

*If you believe physician A is compromised in any sense (for example, a financial incentive for offering surgery, or a physician who is not in his best mental state that day etc.)

*If the treatment option is undesirable to you and you seek genuine alternatives.

What constitutes a second opinion?
For an opinion to be called ‘expert and professional,’ certain basic rules should be followed.
1. Physician B should be an expert in the field.
Physician B should be of the same expertise as physician A. Taking the opinion of a neurologist (because you know him/her) in matters of, let’s say, a knee transplant can’t constitute an expert opinion. In such cases, asking yourself this question may help you: Would I have taken a neurologist’s professional advice on orthopaedic matters in the first place, or would I let a neurologist operate on my knee? If a doctor can not give you a ‘first’ opinion, he/she shouldn’t be giving you a ‘second’ opinion.

2. A second opinion is sought professionally.
– Consultation is taken in a proper setup; not a casual hallway discussion.
– Physician B has access to all the information that Physician A had. For example, let’s say, a cardiologist suggests an angioplasty to a patient after doing an angiography. Just showing the angiography CD to a different cardiologist and seeking his/her opinion doesn’t constitute a ‘professional’ second opinion because Physician B, in this case, doesn’t have access to the patient’s other clinical information. The same angiographic findings may call for different treatment options in different patients. This has nothing to do with physician B’s competence or intent. It’s simply because Physician B doesn’t have all the required information to come to a valid conclusion that Physician A had.

Continuing on the same thought above, we often value test results more than the clinical judgment that a doctor develops upon seeing a patient physically. As a cardiologist, I am often asked this question: my uncle has 80% blockage and the doctor has advised a stent. What should I do? My answer invariably becomes “I don’t know”. As a doctor, I know what 80% blockage means, but I don’t know what 80% blockage means in someone’s uncle unless I know the patient’s rest of the medical history and current condition. A clinical insight that a doctor gathers upon seeing and talking to a patient can not be substituted by any test.

When to seek a second opinion?
The timing of second opinion matters. I strongly urge you not to seek a second opinion once treatment or surgery has been done already (unless you are seeking legal recourse). If physician B tells you that the surgery you underwent was not needed, you get hurt twice. Once by the unnecessary surgery, and now your disturbed psychological state that will spend the rest of your life thinking about that unnecessary procedure. Mind you, just because Physician B said something different than Physician A, this doesn’t imply Physician B is correct. It is likely that you will continue to seek further (third, fourth) opinions as a tiebreaker.

Before deciding to go for a second opinion, get a good insight into the active condition. Certain decisions are time sensitive like when someone is having a heart attack, stroke (paralysis), cardiac arrest (heart stopped working), major accident, childbirth, eye injury, allergy reaction, critical values too low (like blood sugar, oxygen, blood pressure, heart rate etc.) or too high (blood pressure, heart rate etc.). In such situations, delaying treatment for minutes to hours (even when you doubt the expertise or intent) can have devastating consequences. Seeking a second opinion in these situations may delay treatment, which can be detrimental.

Medical scenarios that are not time-sensitive and potentially have a long-term effect on your health certainly deserve a second opinion. For instance, when someone diagnoses you with diabetes or hypertension (both diseases require lifelong treatment in some form). Similarly, there is a need for cardiac bypass surgery or stenting (in non-urgent situations), heart valve replacements, knee/hip replacements, non-urgent surgery of any kind, cancer treatment and many others; all these examples are fair deals for seeking a second opinion.

How do I seek a second opinion?
As I described above, discussing the case with a doctor over the phone, online, or just showing some reports is not the right way to seek a second opinion. If you seek an expert professional advice, you should do it professionally. This means making an appointment with the doctor, meeting the doctor at a designated time/place, with the patient preferably, and all relevant medical records, films, tests, medications, etc. If you use shortcuts, you are destined to get mediocre advice even if the physician is best in class.

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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