The cornerstone of medicine is to conform to principles of “Beneficence” (obligation to help patients, to provide accurate diagnosis and treatment) and “Non-maleficence” (obligation not to harm patients, protect patients from misdiagnosis and errors)
“Second opinion” is the term used in medical services for an additional consultation with another physician, required either by the attending physician or by the patient.
Second opinion, though a ratification tool that critically influences diagnosis, treatment, and prognosis; ultimately remains the choice of the treating doctor or the patient being treated.
Second Opinion may be considered in the following situations:
1. Before considering any critical elective surgery or treatment which involves prolonged treatment or high risk during the procedure / treatment or high cost.
2. Problem prone cases:
a. As defined by personal experience
b. As defined by department or hospital experience
c. As defined by medical literature
3. Cases flagged by referring clinicians – involving challenging Diagnosis.
4. Rare disorders that have clinical importance.
5. Patient seeking a second opinion to confirm the first opinion / self-assurance.
6. For conditions outside the primary physicians area of expertise.
7. Not able to reach conclusive diagnosis or unclear challenging diagnosis.
8. Conflicting test results – results not matching clinical presentation.
9. Detection of major fetal abnormalities.
If the second specialist agrees with the first opinion, it will be very reassuring to the patient and his family.
Role of Third Opinion:
Third opinion may be sought if first two opinions are conflicting or diverse, which result in dilemma for the patients for their diagnosis or treatment options. In such cases patients should opt for a third opinion from a reputed or experienced consultant.
Relevance in India
Seeking second opinion certainly it is not a reflection of a clinician’s competence but the desire to do the best for the patient. Still many of our specialists are sensitive about suggesting a second opinion.
Appropriate and effective communication with a patient with regard to reason for a second opinion will surely allay fear and build the trust of the patient.
Frequent allegations of misdiagnosis and inappropriate care would be mitigated by the doctors suggesting/ seeking a second opinion.
Practice of evidence based medicine, reinforced by second opinion will reduce patient and consumer court complaints.
A study of 466 surgical oncological patients concluded that “one third of patient-initiated second opinion consultations resulted in a discrepancy with the first opinion” and that half resulted in “major changes in therapy or prognosis” (EJSO 2006; 32:108-12). Another study of 814 cases of patients facing head and neck surgery found that a second review of the pathology “resulted in 7% changed diagnoses.” (Head Neck 2002; 24:684-93).
The effective use of second opinion in diagnosis is a subject that needs to be better communicated to clinicians and patients. Enhanced efforts are needed to educate doctors and the public on this important patient safety mechanism. Expectations should be on par with the accepted standards of care.
All parties should recognize that the pathology diagnosis is a complex human endeavor that is difficult and not entirely infallible.
In the best interest of the patient and to uphold honor and ethical practice, the medical fraternity should proactively consider offering the option of second opinion, whenever it is appropriate.
By Dr. Nagendra Swamy
Disclaimer: The views expressed in this article are of the writer and not of the hospital.