Julia expressed her frustration during our patient visit. After being dismissed by two other physicians who told her nothing was wrong, she had grown agitated with the medical system. Julia, a pediatric patient, was convinced something was just not right — and trusting Julia’s judgment, her parents remained steadfast in seeking other opinions. I was the third physician Julia saw, and after hearing her symptoms, her diagnosis was apparent — she had a heart rhythm disorder. Fortunately, we were able to cure her electrical problem with a procedure called a catheter ablation, but the family was still exasperated from the whole experience. “How was this missed?” they asked me. The answer is often complex, but certainly worth exploration.
For Specialists, Diagnosis Can Be Difficult
As a specialist in treating pediatric heart rhythm disorders, Julia’s diagnosis was quite obvious — simply because this is a condition I am very familiar with and see routinely. As a testament to Julia’s conviction, and her parent’s faith in her conviction, they were able to access a specialist that could provide an answer. I am certain that non-cardiac or rhythm-related diagnoses have not been detected by my relatively narrow bandwidth in the past. Like many specialists practicing today, the majority of ailments and diseases outside of our area of expertise can be difficult to diagnose because we have little to no experience treating them. Often times, these ailments haven’t been seen in our clinical practice since medical school — and in some circumstances, they have never been seen at all. Perceived largely as an advantage in modern medicine, and by many patients, sub-specialization has its limitations. I would argue, in fact, that the role of the primary care physician has been undervalued in our current medical system. Finding the “right” doctor is commonly the obstacle to a correct diagnosis and appropriate medical care, rather than the competency of the doctor. With the barriers posed by insurance companies, finding the “right” doctor has become even more challenging.
Building a Trusted Doctor-Patient Relationship
Certainly, as in Julia’s case, the basic tenants of a detailed history and physical examination will diminish the probability of “missing” a diagnosis. Julia’s description of rapid onset palpitations, which occur without warning, was a clear indication that this was not a physiologic process. Perhaps it was obvious to Julia, who was certain something was not right, and these strong convictions are telling — as patients tend to know their queues much better than a physician ever can. Being sensitized as a sub-specialist was fortuitous in this case. Despite that good fortune, our reflex to dismiss symptoms that we do not understand is short-sighted and potentially dangerous. Perhaps arrogance plays a role, but regardless, our admission to not knowing, but being concerned, should be an accepted and appropriate response. Of course, in this scenario, a physician should provide acceptable consultation and steer the patient toward an expert in the field. Acknowledging that the patient’s symptoms are valid is the building block to establishing a trusted doctor-patient relationship. Finding them the “right” doctor only reinforces that trust.
Not every doctor-patient interaction is favorable, and not all patients trust what their doctor prescribes and concludes. As physicians, this must be an accepted and anticipated aspect of our medical practice. More importantly, our obligation is to provide an avenue that optimizes their medical care. In some cases, referring a patient for a second opinion is appropriate and should even be facilitated by the referring physician. It is not uncommon that I suggest to a patient or family that they seek another opinion if I sense discomfort or distrust in my recommendations. Ultimately, without that as an established precedent, successful treatment and outcomes fall short. Furthermore, physicians who are reluctant to or impede the process of obtaining a second opinion are keeping the patient’s best interest in mind.
The Stigma of “Cheating” on Your Doctor
Another aspect of the delicate doctor-patient relationship that is exposed by the prospect of obtaining another opinion is the fear of insulting or offending the primary physician. Patients and families with a long-established rapport can be intimidated by the notion of “cheating” on their doctor. Understandably, this can be an uncomfortable situation. Nevertheless, a physician that respects patient autonomy and is interested in optimal patient outcomes will do his or her best to facilitate this process. Providing records and even communicating with the referred physician are signs that your doctor is an advocate for your health.
Ultimately, any discomfort in a prescribed diagnosis or treatment plan should prompt another opinion. Patients can be their own advocate and find the most appropriate physician for their suspected disease. Even if the end result is the same prescribed strategy, hearing this from two independent clinicians not only provides comfort, it achieves the objective.
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Why Getting a Second Opinion Matters originally appeared on usnews.com
