Second Opinions

Illness has been the name of the game for the past two weeks at the Shapiro household. It started with my son, then moved to me, my wife, and finally my daughter. Unfortunately, two-year-olds don't handle illness as well as adults, and a few nights ago we ended up in the urgent care center with a hot, floppy child with a 103.5°F fever. After waiting two hours, we finally saw the physician who never told us his name, shook a hand, or even gave us a diagnosis. We left with a prescription and a sense of dissatisfaction. (Besides the fact that we waited so long, my daughter actually broke her fever in the urgent care!)

Unhappy with the care my daughter received, we made an appointment to see her pediatrician for a second opinion the next day. My wife received exactly what she expected: a thorough examination, specific diagnosis, and confirmation that the prior prescription was appropriate. Most importantly, my wife had peace of mind and a greater feeling of empowerment.

Let's talk a bit about the second opinion appointment, so we can all provide the better quality care we received from our pediatrician.

When You Are Asked for a Second Opinion

Just about every doctor in practice receives requests for second opinions and it behooves each of us to know how to handle these. Here are a few pertinent pointers to keep in mind when seeing a patient for a second opinion.

Guidelines for Providing Proper Second Opinions

	1.	Be prepared. Train your office staff to request records and prior imaging before the actual appointment to allow you to prepare ahead of time. Since these are often more complex cases, they have the tendency to eat up your clinic time. Having information beforehand will prevent long delays.
	2.	Be respectful of prior treating doctors. At no time during the appointment do I insult or second-guess the prior treating doctor. I NEVER tell a patient they should sue someone. If someone asks for this type of information, my response is something like, "I wasn't there in the operating room, so I can't tell you what happened. I can only tell you what I see now, so let's focus on the current situation and move on."
	3.	Watch out for red flags. A patient who seems to be fishing for a lawsuit is dangerous. Get away if you can! The patient who has seen five other doctors, none of whom were successful in treating the patient, is also a red flag. If you think you're so good that you're going to fix that patient where every other doctor failed, then you're most likely deluding yourself.

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	4.	Remember why the patient is seeing you – for an opinion. There's nothing more annoying to a patient than seeing a second doctor and not actually receiving the opinion or further information they are seeking. Give them your honest, comprehensive, professional opinion. Educate and empower.
	5.	Be thorough. Since treatment is not the purpose of the appointment, you can make recommendations, but you will not institute treatment. The office time you lose gathering history and discussing your opinions will be made up by your not treating the patient.
	6.	Don't steal someone else's' patient. Remember this is a second opinion. Send the patient back to the prior physician. If the patient desires to remain with you, then communicate this in some way to the prior physician, via phone call or at least a copy of your consultation. I always urge the patient to return at least one more time to the original treating physician.

When YOU Need a Second Opinion

	1.	Be aware. There are many times when a physician needs another opinion. Know when a new opinion would be helpful. Understand that the second opinion is a tool to help your patient (and sometimes to end the relationship when you either can't or don't want to treat any more). Referring your patient to someone else is not a poor reflection on you. Treating outside of your scope or training is.
	2.	Use your staff. Have your office staff make the appointment for the second opinion. Don't leave it up to the patient. This will improve compliance, making it more likely your patient will actually go to the appointment.
	3.	Know your colleagues. Your community will have a broad number of various specialists to whom you can send your patients. Some of these specialists will work better with certain patient types and pathologies. Some of these specialists will be more trustworthy with delicate situations. Know whom to refer to.
	4.	Follow-up. Be sure to follow your patient after referring them for the second opinion. I typically set up an appointment with me for after the patient has seen the other doctor. In this way, I know they've actually followed my advice and gone to the appointment and what information they've received. Remember, the purpose of the referral was to help your patient solve her medical problem. If you don't follow-up, you can't benefit from another's advice.

Just like orthoses, injections, the scalpel, or the prescription pad, a referral for a second opinion is another instrument in your toolbox to help your patients. Used correctly, the second opinion will build your practice through honest, comprehensive patient care and, simply, good medicine.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
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