My Opinion About 2nd Opinions

12 May 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.