My Opinion About 2nd Opinions

My Opinion About 2nd Opinions

I like second opinions.  I believe they can be very helpful to both my patients and me.  I have been in private practice for about 16 years.  I used to practice in Baltimore, Maryland, very close to the Johns Hopkins University, which is home to the best (for this arguments sake) ophthalmology department in the universe.  In the beginning, consumed with establishing myself and developing a practice, I cringed at the request of a “second opinion.” 

The second opinion used to insult me.  It used to scare me.  I was well trained, but how come the patient didn’t believe what I said?  Where did I go wrong?  I would get paranoid and would think that every other patient would get up and leave, too.  They were going to the other practice across the street and tell them how bad I was.  They would go to Johns Hopkins.  How could I compete?

With time, my tune changed.  Obviously, none of these things happened (I had a very successful 14 years in Baltimore).  Patients started coming to me for a second opinion.  Better yet, patients were returning after going somewhere else!  I am somebody!  I am that good!  I will be able to eat and support my children!

Actually, I am somebody.  Actually, I am pretty good.  I am pretty good about getting my message across to a patient in a reasonable amount of time and in a way to establish trust.  It took me years to learn the latter.  It took me years to learn that second opinions are also a way that patients can understand a very complex and scary situation for them.  They need a second opinion as a student needs a tutor. 

Cataract Surgery is Intuitive   I think most people understand cataracts, that is, it is intuitive.  Cataracts cause decreased vision.  Cataract surgery improves vision.  Simple.  What not to get? 

Patients are only so smart about retinal disease – with or without the internet.  Retinal disease is counter-intuitive.  It makes no sense.  Most people never even heard of the retina.  Retinal disease; however, is potentially blinding.  It is serious stuff.  It takes lots and lots of time to explain, and re-explain.  Our definition of success usually doesn’t include improved vision.  It is hard to understand the outcome is often less than expected.  These are the real reasons for second opinions.  Patients need clarification, reinforcement of outcomes.  They need to be told, by someone else, what is going on.

If medical care were like a roof we’d call second opinions “estimates.”  Everyone gets estimates.  We don’t want to get cheated about something we don’t understand.  Pretty similar to the medical example, we need to learn and understand.

Second Opinions Make Us Closer to our patients.  For instance, if a patient seeks a second opinion and the recommendation is the same as what I had indicated, it validates me.  Someone else has confirmed what I had just told the patient.  This is a good thing.  It says I am a trusted source.  It makes my relationship with my patient stronger.

Second Opinions Can Make My Life Easier  Every once in a while there is a patient that has to go to the best hospital and be treated by the doctor of the stars.  I am not that doctor.  I wish those patients well.  It makes my life simpler.

And Finally  I encourage my patients to seek second opinions.  It only validates me and my methods.  My advice, should anyone ever ask, is to treat your patient as your children.  Let them go, encourage them and embrace them with open arms (yet humbly) upon their return.

  • Natalie
    Posted at 05:40h, 15 May Reply

    I’m glad to read your comments on 2nd opinions, Dr Wong. I’ve had a lot of experience with second opinions since being blown up by a roadside bomb in Iraq a year and a half ago! I feel sorry for the docs who get defensive and/or nervous when I say that I’m seeking, have sought, or will seek a second opinion – I often try to joke them out of that and let them know it’s not about THEM, it’s about ME. I can like a doctor, trust a doctor, think they’ve done a great job, and still I might get a second opinion – especially on my eye injuries – because what if there’s something they didn’t think of, or something new that one specialist knows about but this doc of mine hasn’t had experience with yet? I could tell ten stories of people who’ve been to sixteen doctors, then suddenly found one who said “Oh, we can do x – I’ll send you to the person who knows that procedure best in Switzerland/ Minnesota/ Seattle/ Toronto/ … ” and the results were that the person regained sight, or was otherwise helped.

    I was treated in Iraq, Germany, and at Walter Reed Army Medical Center by military doctors, and while I think they did a fantastic job with all my injuries, I got a lot of eye-rolling from civilian friends, and heard nasty comments about military docs not being anywhere near the top of their field. I always defended them (sometimes rabidly – I fell in love with half of them! I think this must be common for long-term patients ), but really, I didn’t KNOW if they were good or not, really, because I had nothing to compare them to since I’d never had severe injuries of any kind before. So EVEN THOUGH I was in love with them and thought they’d done a fantastic job on my foot, wrist, head, face and eye … I sought second opinions.

    The result? Now I KNOW without a doubt that they’re some of the top doctors in their fields, and I KNOW that they did a fantastic job with my injuries. Now we’re all happy – I’m in good shape thanks to them, and I’m a mouthy admirer of military health care!

    As patients, we have this huge pool of doctors to choose from, but often the only way we really know we’ve done all we can do for ourselves is by getting more than one opinion and talking to other patients, comparing injuries, doctors and treatments. Your comments about 2nd opinions being like getting estimates on a construction job for the house is dead on!

    OK, this is long and you’re probably thinking “Get your own blog, sister” – just one more comment: I enjoyed meeting you yesterday at my appointment for a second opinion (I’ll be recommending you to a couple of friends). We talked about retinal surgeons being a different sort of person than other eye doctors, and I think I can confirm that’s true. All the ones I know (I think that’s 6 to date) are people that I’ve enjoyed and respected – razor intelligence, no pussyfooting around on ‘hard’ news, and a good quirky sense of humor. You guys are the best, right up there at the top with the maxillo-facial doctors! Thanks for doing what you do.

  • D. Lee
    Posted at 13:07h, 17 May Reply

    I found your comments on second opinions to be very interesting and insightful. As a management consultant and avid investor/trader, I deal a lot with decisions made with high degrees of uncertainty. The uncertainty involves complexity beyond our ability to completely know and understand, just as in medicine. Of course, uncertainty spells risk. By contrast, in medicine, there are way too many marbles on the table, which takes all the “fun” out of it.

    For me, second opinions help to address the emotional factors (e.g. fear) involved in making decisions in this area. They often provide references to confirm the bases of decisions, additional rationale that support the confidence to proceed, comfort in the idea that another expert has viewed the situation and agrees with a course of action, sometimes alternate approaches that might be preferred etc. As you know, we (patients) don’t understand much of what we’re hearing from a technical standpoint. Sometimes we just need a push to screw up the courage to “pull the trigger.” I’ve had to get to that threshold a few times.

    The urgency of the vitrectomy saved both of us from that process. I am grateful that you accommodated my need for a quick response and that the procedure is showing the signs of success.

  • JulieW
    Posted at 20:57h, 13 April Reply

    Very powerful post !!!!

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