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.

[Tudor Geneve]

Hippocratic oath

[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.)

[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!

[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! :) )

[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.

[Brunotheboxer]

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

"I got your second opinion right ovah heeere."

[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?

[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.

[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.

[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 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.

[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?

[Lisa]

Why would you assume that trust between you and the patient was compromised because they sought another opinion that only reinforced your treatment plan? If anything, it should have solidified your relationship.

Sorry, but I'm just a bit bewildered.

[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.

[johnbeth]

Originally Posted by watchf

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

Originally Posted by watchf

In your opinion how would you manage the ongoing care?

You are a doctor and I would have thought part of your training would be on how to manage situations like this. I would have thought its your duty to help patients regardless on how many opinions they got. You must provide the care that has been advised to the patient and finally agreed by the patient.

[watchf]

Originally Posted by johnbeth

You are a doctor and I would have thought part of your training would be on how to manage situations like this. I would have thought its your duty to help patients regardless on how many opinions they got. You must provide the care that has been advised to the patient and finally agreed by the patient.

John you are generalising too much based on one post. Helping a patient is performed in a variety of methods all with the aim of having an outcome that is the most optimal for the patient. I am asking how each clinician in different field handles/handled it in their experience instead of seeking a template answer hence I posted a thread for responses from the wider audiences here.

[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.

[Rolex Junky]

The patient is entitled to the best medical care available. There is absolutely nothing wrong with him/ her seeking out advice.

[Numismatist]

Junior?:

Well the theory goes: brand new doctors may not have the experience, but they have the latest and freshest training and older docs have the experience - I'd think purposefully going to a junior and newer would be a great thing for a second opinion.

If they're leaving you and sticking with the 2nd opinion provider, that's a market force you'll have to deal with internally.

[Timber Loftis]

Originally Posted by watchf

since trust between the clinician patient relationship is lacking and would not lead to an optimal outcome under your care?

As an FYI doc, I almost always seek a second opinion if anything other than a simple diagnosis is at issue. It's not that I don't trust you guys, it's just that I don't trust people, and despite what your profession may tell you to think of yourself, you're still people.

[johnbeth]

Originally Posted by watchf

John you are generalising too much based on one post. Helping a patient is performed in a variety of methods all with the aim of having an outcome that is the most optimal for the patient. I am asking how each clinician in different field handles/handled it in their experience instead of seeking a template answer hence I posted a thread for responses from the wider audiences here.

You have confused a lot of people here, here is what I think of doctors who dont like patients getting second advise.

My father had health issues and 4 doctors said he had nothing, just prescribed pain killers and did nothing to help while my father was suffering and loosing weight. Doctor Number 5 after 5 months of agony and pain, he said I will help you, he was taken to hospital and performed the same tests the other geniouses had done before and he found cancer. So my father got chemotherapy and now after his treatment has gained back the 15Kilos and more from what he lost while he was suffering due to diagnosis from other doctors. So if you dont like patients getting other opinions, I suggest get sympathy from somewhere else.

[Numismatist]

re-read your post, I'm not sure how you conclude that trust is lacking because the patient went behind your back, it could just be personal embarassment at confronting directly and asking for a second opinion. Many patients are intimidated by doctors and their vastly superior knowledge of medicine; they may simply not know how to ask you if it's OK to get a second opinion.

[watchf]

Originally Posted by Rolex Junky

The patient is entitled to the best medical care available. There is absolutely nothing wrong with him/ her seeking out advice.

Yes hence I ask what have others done or prefer to do in terms of ongoing care management in this situation.