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The Second Opinion

a doctor talking the patient

Lately, I’ve been thinking how the queries I answer on Dok Bru can sometimes be like a second opinion. “My doctor gave me X, but having read your post I’m thinking Y. Do you agree or would you recommend Z?” And since I’m moderating the #HealthXPH tweet chat tomorrow 10 Sept 9 pm Manila time, let’s discuss this further.

A casual PubMed search led me to this article by Lehmann et al (2021) on second opinion consultations in oncology. The authors discuss what makes second opinion consultations different from other medical consultations:

  1. The patient’s motivation to seek a second opinion must be addressed.
  2. Second opinions are triadic, involving the patient, the first physician, and the physician whose second opinion is being sought. This is further complicated when family members and/or significant others accompany the patient.
  3. Second opinions are often designed to end with the patient being referred back to the first physician, which may be contrary to the what the patient expects.

T1. As a physician, how do you ask a patient why they’re seeking a second opinion? Do you inquire about the identity of the first physician? Why or why not? As a patient, do you inform the second physician, that you are seeking a second opinion?

I have patients who casually inform me that they are seeking my second opinion but become discomfited when I ask them who their physician is. The awkwardness intensifies when I inform them that I know their physician. There are after all, only about three hundred endocrinologists in the Philippines.

Sometimes, patients will conceal they’re actually seeking a second opinion. It can slip out especially when I give a divergent opinion. “But Doc, my other doctor said X. It’s a good thing I came to see you, as I prefer to do Y as you suggest.”

T2. If the second opinion is sought after the patient has lost trust in their first physician, do you attempt to restore trust and how? As a patient, what do you look for in a physician when seeking a second opinion?

Trust and loyalty come into play in the triadic setup of the second opinion. I’ve had patients who openly tell me they do not believe in the first physician’s plan of management. But it also may be that the plan is correct but somehow, the patient has lost trust in the physician. Sometimes the plan of management was not properly explained but the patient becomes convinced when the second physician explains it further.

T3. After your second opinion is sought, do you always refer the patient back to the first physician? Why or why not? As a patient, what would make you go back to the first physician?

It is easier to refer the patient back to the first physician when the opinions are congruent. If the opinions are not congruent, I find that the patient will choose the physician whose plan of management coincides with theirs. I never assume that a patient seeking a second opinion will follow up with me and I refer them back to the first physician.

See you at the #HealthXPH tweet chat!

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