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Volume 2, Issue 1
Spring 2006:

Doctor and Patient: Second Opinions

June Bingham and Gerald Neuberg, MD

Cell 2 Soul. 2006 Spring; 2(1):a10

"Should I get a second opinion or just follow doctor's orders"

Dear Doctor & Patient: Will my doctor be insulted if I ask for a second opinion?

Dr. Neuberg: No, not really. You have to be comfortable with what's being done for your health. For things like major elective surgery, second opinions are quite routine. And when patients are openly skeptical about our explanation of diagnosis or necessary treatment, the physician will welcome another opinion, before proceeding with a disputed plan. The doctor may even suggest it, as a way to signal an impasse, to avoid confrontation with a distrustful patient or family, and to see whether they will listen to anyone else.

Ms. Bingham: In spite of what you say, I would worry that my doctor would feel hurt if I asked for a second opinion. He might think I don't trust him or his opinion.

Dr. Neuberg: Clearly a lot depends on trust. If you trust your doctor, you won't be very interested in more opinions, which may just confuse matters. But if you came under the care of a new doctor who was assigned after unexpected hospitalization, you might not feel the same way.

Ms. Bingham: Right, but what if the two opinions don't agree? How is a mere patient to choose?

Dr. Neuberg: You'll consider which opinion was better explained, and which makes more sense or better fits your preferences. Sometimes either course may be reasonable. Some doctors feel obligated to do something, like ordering more tests or changing the regimen, even in a minor way, so patients feel they got their money's worth. When a patient returns to me after receiving some new advice, I can be a good sport and go along or, if I am more comfortable with my original plan, I'll be honest and explain why.

Ms. Bingham: Maybe you and I are talking about two different things. One is the opinion of a specialist, following a first opinion by a generalist. The other is a second opinion by a fellow-specialist (or fellow-generalist). I would have no trouble with the first, but would hesitate about the second.

Dr. Neuberg: I did mean number two. Second opiners generally are pleased to reassure and dismiss a patient who already is receiving appropriate care. But sometimes they will suggest nonessential changes, which I may or may not question. I'd be less likely to overrule an opinion from outside my speciality, but if the patient was uncomfortable with that advice, we could find a second specialist. If this sounds confusing, that's what you get for wanting too many opinions.

Ms. Bingham: Some patients can't get enough of them. I have a friend who adores visiting doctors and keeps going for 3rd and 4th opinions. I suspect that she's searching for at least one doctor who agrees with her.

Dr. Neuberg: "Doctor shopping" is an abuse of the free access we enjoy under Medicare, and unfortunately it's one of the excuses being made by some members of Congress to justify privatizing the whole Medicare program. When I see a patient who was dissatisfied with a previous medical opinion, I do ask what bothered them, so I can avoid making the same mistakes. Sometimes they are only seeking a better explanation or a different kind of attention.

Ms. Bingham: Or maybe they have read something in the paper or the internet, or heard something from a friend, that makes them question the first doctor's opinion, yet feel embarassed to confront him or her about it.

Dr. Neuberg: If a patient were afraid to talk to me, I'd say I haven't done my job.

Ms. Bingham: I am afraid. That's why I write. There seem to me to be two kinds of doctors, those who do not want to be challenged by a patient, and those who don't mind this at all. Similarly there seem to be two kinds of patient, those who automatically do whatever the doctor orders, and those who first want some answers. If the first kind of doctor and patient are paired, all is well, and if the second kind of doctor and patient are paired, all the better. But a mismatch can spell trouble.

This piece was originally published in the Riverdale Press, 11/23/05, and is reprinted with their permission. Doctor and Patient will appear as a feature in Cell 2 Soul. Bingham and Neuberg hope that Cell 2 Soul readers will begin to send them questions of their own for future columns. Readers are encouraged to contact the authors by sending e-mails to DoctorPatient~AT~cell2soul·org, with "Doctor and Patient" in the subject line.

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