Second opinions: Is there a tactful way to handle them?

I gently refuse to give opinion if someone asks my ‘quick feedback’ based on just a single report or a single symptom. And give them the option of a detailed assessment.

If they’re family or a close friend, I try getting the whole picture over phone call, and for this they have to wait till I’m free.

For anyone else, they have to call the appointment number and follow the process. If they feel my advice would be valuable enough to justify the fee and the wait, they follow the process. If they don’t, they stop asking me random questions, and keep looking for some other willing soul.

After the consultation, it’s easy if my Assessment agrees with that of the other doctor. But if there’s conflict, there’s no easy way out of it..

It’s very tempting to let the patient know upfront all the things I don’t agree with – to feel superior to the other doctor, and to give a feeling of justification to the patient for seeking a second opinion.

However it’s very unfair to the other doctor, as we don’t know the history, exam findings, and the thought process which led to the doctor’s assessment and plan.

A somewhat viable option is to refuse to discuss the prescription of the other doctor, and insist that I’m going to give my own prescription based on my own assessment. The patient can choose to follow my prescription or that of the other doctor.

This may work for minor disagreements, or if I’m pressed for time. But it does leave a sense of mistrust and dissatisfaction in the patient’s mind. And it’s not ideal clinically either: the other doctor may have heard or seen or thought of something significant, which they acted on, but forgot to document. That missing piece may change the whole perspective.

The ideal way is for me to call up the concerned doctor and discuss the findings and try to reach consensus on the best possible treatment plan for the patient.

This builds trust for both the doctors in the mind of the patient. This helps us learn and grow as doctors, gives us different perspectives. And this opens the doors of communication with another professional, in an otherwise lonely world of private practice.

It takes time, effort and a lot of tact to do this right. But the results are worth it. I daresay this is the only option that builds trust among all stakeholders, in a system where trust is in short supply otherwise.

So, my dear colleagues, if you see a prescription of mine which you don’t agree with, do call me, my number is there on the prescription. I’ll be happy to discuss with you how to best take care of our patient!

And if you are open to me calling you, feel free to share this where other doctors can see it!

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