Today, no one doctor can claim to have a full grasp of his specialisation
“There are many ways to skin a cat,” is a metaphorical expression often heard at professional conferences when opinions differ on the management of a medical problem. Thus, medicine remains both a science and an art. Opinions will differ and, in certain circumstances, cause considerable confusion and anxiety in the patient's mind.
In the last 50 years, medicine has advanced so rapidly no one doctor can claim to have a full grasp of his own domain of specialisation, much less the various branches of medicine. Other influences that have impacted the way medicine is delivered to the patient include the lack of finance/insurance support, the loss of the family doctor, and more recently, the corporatisation of medicine where a patient becomes a client.
What is second opinion?
In this milieu, a patient, already at a disadvantage from ill health and conflicting influences, often wishes he could have a second opinion. This means having another consultant or set of doctors re-examine the patient, review the data and suggest a plan of treatment. It may agree with the one in place, or be entirely new. A cross reference, however, is the request of the primary doctor to another colleague for an expert opinion on a particular issue in the patient's management.
When is it sought?
Usually, when there is loss of confidence and trust in the opinion or treatment advocated by the doctor — the patient is not getting better, or a certain procedure or investigation is being forced upon the patient.
Or when it comes to a life-changing treatment, e.g., cancer, amputation of a limb, or withdrawal of life support.
The doctor may suggest one if unsure of the diagnosis.
In this information age, the patient may have researched the problem and may wish to see another consultant. However, remember that information on the Internet is often not peer-reviewed and can be misleading.
Is the patient entitled?
In health systems where the state bears the burden of health care, like the National Health Service in the United Kingdom, the patient does not have the right to a second opinion but is permitted to seek one.
Similarly, in the organised sector like the government or the military or where medical insurance pays for healthcare, logistically it becomes near impossible to get a second opinion unless the treating doctor allows and/or recommends one. In all other cases the patient reserves the right to a second opinion.
How to go about it
“Shopping for an opinion” is a very sorry practice in the country. Rather, the patient should have a clear objective and proper preparation before seeking a second opinion. A good approach would be: Inform the doctor that a second opinion is being sought. It builds trust; the doctor may suggest someone of equal or superior ability and provide all the documents and investigation reports. This will save time and money.
Identify a consultant of equal or superior training or stature. It is pointless to have a generalist opine on a specialist's opinion. Beware of unsolicited advice.
Collect originals and reports of all investigations, including imaging, and have them carefully tabbed. All of these rightfully belong to the patient.
Ensure that the new consultant interviews and examines the patient and then reviews the reports. The patient should be seen as a whole person and not only as a medical report.
Communicate openly and clearly and share the second opinion with the primary consultant. Doctors cannot deny a patient the right to seek a second opinion and should preferably suggest one where appropriate.
No need for egos
Notwithstanding our egos and prejudices, we must be sensitive to patients' rights and be willing to help in every way.
Hopefully, the development of standard treatment guidelines (under way in many specialties) and peer-reviewed, evidence-based protocols if made easily available to the public will empower them to make better informed decisions. Our only objective should be to make patients better: if we cannot, then we must respect their inalienable right to a second opinion.
( The author is the Director and Senior Consultant Paediatric Surgeon/Urologist at the Narayana Hrudayalaya Woman and Child Institute. He is also the Past President Indian Association of Paediatric Surgeons. )