How do you guys handle patients going for 2nd opinion behind your back?

[watchf]

I realise there are a quite a number of members here who are frontline clinicians hence I put forward this question;

How do you (in your practice) deal with patients seeking 2nd opinion behind your back and subsequently have the clinician who did the 2nd opinion get back to you and agreed with your treatment who then request you to continue the care of this patient? In the whole process the patient never did inform you that they had seek or planning to seek a 2nd opinion.

What would your reaction/thoughts be if the clinician who provided the 2nd opinion is extremely junior in terms of experience in your field telling you (an experienced senior practitioner) that after going through your clinical management of the patient found that it is appropriate?

Just to clarify, I intentionally used the term clinicians instead of a specific health profession so as to include all frontline health clinicians.

Addition: I'm not saying if its right or wrong, what I am asking is what your management plan would be after that. Would you in your normal practice resume management of the patient or would you rather transfer the care to the clinician who provided the 2nd opinion (the last clinician whom had contact with the patient) since trust between the clinician patient relationship is lacking and would not lead to an optimal outcome under your care?

[mtrunner]

I think you have a smart patient. There is absolutely nothing wrong with asking another doctor a second opinion. As a doctor you should encourage it if you have a hesitant patient. You shouldn't feel threatened by this. Too many people put their faith in one doctor's hands and should have went to another doctor for a second opinion and would have possibly benefited from a different diagnosis and treatment. Doctors are human and mistakes can be made. I should note I am not a practicing clinician but I an epidemiologist working in a non-profit cancer research insititute. Our cancer patients often get 2nd and 3rd opinions before engaging in any treatment options.

[chicfarmer1]

Originally Posted by mtrunner

I think you have a smart patient. There is absolutely nothing wrong with asking another doctor a second opinion. As a doctor you should encourage it if you have a hesitant patient. You shouldn't feel threatened by this.

Bravo. The top-tier practitioners I've encountered are secure about this.

As a consumer and not a provider, I believe it's an essential patient right and one that had better not ding me with my doc in the event that I exercise that right. (And physicians or their staff can unwittingly, if not overtly, transmit having a problem with it.)

[linkinghabit]

Originally Posted by chicfarmer1

Bravo. The top-tier practitioners I've encountered are secure about this.

As a consumer and not a provider, I believe it's an essential patient right and one that had better not ding me with my doc in the event that I exercise that right. (And physicians or their staff can unwittingly, if not overtly, transmit having a problem with it.)

i agree.it's everybody's right and sometimes we don't have to tell that we are for 2nd or even 1oth opinion, i think physicians already knew things like that happens..

[SaddleSC]

Originally Posted by mtrunner

I think you have a smart patient. There is absolutely nothing wrong with asking another doctor a second opinion. As a doctor you should encourage it if you have a hesitant patient. You shouldn't feel threatened by this. Too many people put their faith in one doctor's hands and should have went to another doctor for a second opinion and would have possibly benefited from a different diagnosis and treatment. Doctors are human and mistakes can be made.

100% Agree. Doctors are human; they make mistakes. It would take a very insecure doctor to be "offended" by a patient seeking the best medical care possible, especially when the consequences are often life and death.

[Tudor Geneve]

Hippocratic oath

[Passionata]

i even ask for a third

[Lisa]

I ran this by a physician I know rather intimately... he said of of course patients should get second or third opinions. It means they're smart about getting the best care/treatment.

I know that I sure would seek other opinions - and if my primary doc was upset in any way that I did this "behind his back," I'd find another doctor.

[johnbeth]

Originally Posted by Lisa

I ran this by a physician I know rather intimately... he said of of course patients should get second or third opinions. It means they're smart about getting the best care/treatment.

I know that I sure would seek other opinions - and if my primary doc was upset in any way that I did this "behind his back," I'd find another doctor.

X2....

This is not childs play. My health is important to myself and I will get as many opinions as I like! If my doctor doesnt like it, well he can go and roger himself as it shows arrogance and humans do make mistakes even the best of them!

[kcmo]

Originally Posted by Lisa

I ran this by a physician I know rather intimately... he said of of course patients should get second or third opinions. It means they're smart about getting the best care/treatment.

I know that I sure would seek other opinions - and if my primary doc was upset in any way that I did this "behind his back," I'd find another doctor.

Well said!

[CoopJr]

Originally Posted by Lisa

I ran this by a physician I know rather intimately... he said of of course patients should get second or third opinions. It means they're smart about getting the best care/treatment.

I know that I sure would seek other opinions - and if my primary doc was upset in any way that I did this "behind his back," I'd find another doctor.

I thought he was a 747 pilot?

[Route 66]

I would't want a doctor that felt uncomfortable about my seeking a second opinion. That would indicate to me that he wasn't a very confident physician.

[Lisa]

Originally Posted by CoopJr

I thought he was a 747 pilot?

He thinks so, too!

"I'm not a real pilot, but I play one on the computer...."

[CoopJr]

Originally Posted by Lisa

He thinks so, too!

"I'm not a real pilot, but I play one on the computer...."

LOL!

[threemonkeys]

Originally Posted by Lisa

I ran this by a physician I know rather intimately... he said of of course patients should get second or third opinions. It means they're smart about getting the best care/treatment.

I know that I sure would seek other opinions - and if my primary doc was upset in any way that I did this "behind his back," I'd find another doctor.

X2. Gone are the days of the single all-knowing physician. Patients are consumers and, in my book, have complete control over how they choose to manage their health care. And this includes getting multiple opinions regarding their treatment.

[RolexWatcher]

watchf, would like to understand what your feelings are because I see nothing wrong with getting a second opinion.

Is it because the patient went "behind your back"? But I see nothing wrong with that.
Is it because he went to someone that is junior? Nothing wrong with that either.
Is it because the junior "approved" your senior clincian's analysis? Nothing wrong with that either.

Maybe you care about this patient too much and so thinks this other opinion is "inferior" but remember it's the patient's decision at the end. You need to be careful you don't come across as an arrogant doctor to the patient. It's a fine line.

(I am assuming your example refers to you as the doctor - sorry if that is wrong! :) )

[Brunotheboxer]

I bash their heads into the trunk of their car while saying the following.

"I got your second opinion right ovah heeere."

[Dr. Robert]

Originally Posted by Brunotheboxer

I bash their heads into the trunk of their car while saying the following.

"I got your second opinion right ovah heeere."

I take the patient back & usually leave stuff inside the patient after surgery,
bits of surgical tools etc.

[keschete]

Originally Posted by Brunotheboxer

I bash their heads into the trunk of their car while saying the following.

"I got your second opinion right ovah heeere."

Seriouly though, I don't have problems with patient's getting second opinion's even if it is "behind my back" because I understand that some patient's think their provider might get upset with them.

They think that providers expect to be trusted and believed and the patient might be concerned, confused or nervous and just want to make sure another provider thinks the same thing as the first. I understand that because, sometimes, we as providers don't get down on the patient's level.

As an NP, I frequently have patient's compliment me on how I explain things to them in a manner they can understand, sometimes they are just scared and feel like medical providers talk over their heads.

I would take the patient back with open arms and forget about the whole episode. The patient will trust you more in the future and might not feel scared to ask more questions and get second opinions without telling you.

[watchf]

Thanks for the replies so far but I should have made my question more precise. I have added to my original post.

[RolexWatcher]

Originally Posted by watchf

Addition: I'm not saying if its right or wrong, what I am asking is what your management plan would be after that. Would you in your normal practice resume management of the patient or would you rather transfer the care to the clinician who provided the 2nd opinion (the last clinician whom had contact with the patient) since trust between the clinician patient relationship is lacking and would not lead to an optimal outcome under your care?

Ask your patient what he wants to do. TBH, I think you are going a little overboard on the whole "trust between the clinician patient relationship".

Yes, it might feel like you are being "scrutinized" on every opinion you provide to the patient, but it's the patient's choice. It's his/her life.

If you were in his/her shoes in a field you have absolutely no idea about and it can affect the rest of your life, wouldn't you do the same?

[MonBK]

"Dead doctors don't lie".

Do yourself a favor and read the book.

[johnbeth]

Originally Posted by RolexWatcher

Ask your patient what he wants to do. TBH, I think you are going a little overboard on the whole "trust between the clinician patient relationship".

Yes, it might feel like you are being "scrutinized" on every opinion you provide to the patient, but it's the patient's choice. It's his/her life.

If you were in his/her shoes in a field you have absolutely no idea about and it can affect the rest of your life, wouldn't you do the same?

The OP seems very sensitive about his own feelings rather then focusing on the patient at hand to provide best possible care.

[watchf]

Originally Posted by johnbeth

The OP seems very sensitive about his own feelings rather then focusing on the patient at hand to provide best possible care.

Pardon me John but that is over generalising based on the lines of open questions I fielded in one post.

[RolexWatcher]

Originally Posted by watchf

Pardon me John but that is over generalising based on the lines of open questions I fielded in one post.

watchf, although I am sure you mean well for the patient, unfortunately that is how it is coming across and hence that's why I said it's a fine line.

[watchf]

Originally Posted by RolexWatcher

watchf, although I am sure you mean well for the patient, unfortunately that is how it is coming across and hence that's why I said it's a fine line.

Vincent I really appreciate your non judgmental approach to answering my post by focusing on the question rather than emotion. I would like to hear about how each individual has handled it or will handle it.

[dddrees]

So they asked for a second opinion. There shouldn't be any reason why you shouldn't continue to treat as long as the patient ultimately concurs with your assesment of the situation. Don't take it personally that they sought another doctors opinion, however take it as a professional reafirmation that you are doing your job correctly when the second doctor agrees with your assesment of the situation.

[masterserg]

I don't see the problem, it is MY health and I would seek as many opinions as I need until I feel comfortable. What the doctor thinks would be the least of my concerns.

No offense, but an experienced doctor should understand and support this behavior with the patient's benefit in mind (both my parents are physicians with 40+ years of practicing and this is something I discussed with them on several occasions).

[2th Dr]

I have no problem with my patients seeking a second opinion. In fact if they have any doubt, I encourage it.

[watchf]

Originally Posted by 2th DR

I have no problem with my patients seeking a second opinion. In fact if they have any doubt, I encourage it.

In your opinion how would you manage the ongoing care?