Managing the request for a second opinion

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We have all faced the situation when a patient requests a second opinion regarding a test, procedure, or surgery. When the patient seeks a second opinion, the opinion of the second doctor may be different than yours. As a result, the patient may become confused, wants a third opinion, or accepts the advice of the second opinion. This article discusses a practical approach when a patient requests a second opinion.

Why do patients request a second opinion?

• They have a rare condition and seek a physician who might have more experience or training
• There is confusion about the doctor's diagnosis or the treatment options, and the patient wants more information
• The patient's symptoms have not improved after a recommended treatment
• The patient wants assurance that all treatment options have been presented
• The patient believes that the diagnosis is incorrect

Let me share a second opinion story that happened early in my career. I diagnosed a young man with a solid mass in his testis, confirmed with ultrasound and elevated tumor markers. I suggested an abdominal CT scan, a chest X-ray, followed by an orchiectomy. The patient wanted to obtain a second opinion. The other urologist recommended a course of antibiotics, and that the patient should return in two weeks for a follow up examination. I thought this was incredulous. I suggested that the patient obtain a third opinion. I directed the patient to the medical school. The third urologist agreed with my recommendation. That experience taught me a lesson that I would like to describe.

First, when a patient requests a second opinion. Take the high ground. Agree with the patient's request. Think of the Golden Rule: Wouldn't you obtain a second opinion if you were to have a major elective procedure? I know I would.

Next, provide the patient with recommendations from like-minded, ethical physicians. This places the patient in the hands of someone who will provide the patient with an honest second opinion.

Once the patient has selected the doctor for the second opinion, reach out and contact the second opinion doctor and describe the clinical situation. Ask the second opinion urologist for a follow-up call or note regarding their opinion.

Finally, make copies of the patient's medical records, give them to the patient, and send a copy to the doctor chosen by the patient. This avoids the situation of the second opinion requesting the records after seeing the patient or the second opinion repeating tests which also delays the patient's treatment. This last step indicates to the patient that you are making every effort to be helpful and a caring and cooperative physician. Also, this avoids the situation of the records being misplaced in the second opinion’s office since they do not have any information of the patient in their medical records. Also, if the patient wants a third or fourth opinion, they have copies of the records to show additional doctors.

Bottom Line: You can expect that patients will occasionally request a second opinion. Following these steps ensures that there is continuity of care. Also, this approach increases the likelihood that the patient will return to you for treatment.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.