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Thread: 2nd/3rd opinions

  1. #1

    2nd/3rd opinions

    How does one deal with second or third opinions? The reason why I ask is this. We all know that many providers, even when not dealing with an SCI patient, give short shrift to a decent physical exam, much less a thorough ortho/neuro exam when visiting a specialist. When confronted with an SCI patient who may not present in the typical manner in terms of signs, symptoms or response to typical exam procedures, the problem is even worse.

    Thus, many of us have experienced frustration that we will go to a doctor we feel has not given our problem sufficient workup. Add to this the common practice that providers immediately go to some type of imaging and that if nothing shows up, then in their opinion, nothing is wrong. Therefore, we often have a need for a second opinion.

    In my experience when you go for the second opinion physicians typically assume that the prior physician is correct and that the problem must be the patient in front of him/her. They typically do not want to show another physician to be incomplete, incompetent, dismissive, etc.. One does also not want to badmouth another physician. Yet, we are seeking another opinion because we feel that we have perhaps been incompletely worked up. In essence, the second opinion physician typically is "tainted" by the medical records of the first physician.

    Therefore, does one bother telling the second physician about the first physician to avoid any prejudicing of their workup and ensure that they start from scratch and reach their own conclusion? Provided no substantial tests have been done, this is not a unreasonable approach. However, when there are MRI/CT or other substantial diagnostic tests done and one does NOT provide this to the second opinion physician and they order one for you then you are caught between a rock and a hard place. Either you have the tests done again, which may not be approved and paid for, or you tell the doctor that yes, you had these tests done already. In this case, you will have been less than honest with your new physician and the chances of a constructive relationship are essentially nil, as he/she will ask you why you did not tell them before.

    I saw a highly respected hand surgeon who repeatedly dismissed me and blew me off, despite me persevering and pressing for additional workup, which upon being done, showed substantial issues he did not even want to consider. When I requested all of my office notes I found out that there were things said which were not true, I did not say in that way, or things he thought might be a problem, but he did not share with me. When I take this whole stack of notes to the next Dr. they assume that because of his reputation everything in the notes must be legitimate and correct and the problem is me. When I saw my SCI MD recently he said he sent six SCI patients to the same hand surgeon. He refused to treat any of them, finding some reason to opt out. So it wasn't just me. It seems like he just does not want to deal with patients who do not present typically or patients that might have complicating factors. I believe they call this cherry picking their patients.

    I do not believe in doctor shopping until you get the answer you want, but the more physicians you see and have more documentation the downstream physicians I feel tend to view you with a degree of skepticism.

    My feeling is always to be upfront and honest with your providers. But I feel they likewise are not always honest with us as to why they reach the decisions they do. Then again, it is the right of every physician to not treat the patient in front of them, if in their professional opinion they have a reason not to do so (or can conjure one up).

    Anybody find themselves in this position as well?

  2. #2
    You don’t have to share the opinion of one specialist with another specialist.
    if you trust your primary care provider to advocate for you that is all you need.

    this is why people get second opinions

    i wish you the best

    pbr
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    What if you have had imaging or other significant tests done that the second opinion should see that would confirm you saw someone previously?

  4. #4
    I think it's safe to say that doctors come from a very defensive position nowadays, due to restrictions imposed on them by insurance companies and an increase in patient litigation. In the situation you describe, I'd go with very impersonal languaging - something like: "I came to see you because I need to make some treatment decisions, and want to be sure I have the fullest possible picture before I commit to a course of action." Steer clear of criticism of the other doctor or questioning his/her methods and conclusions. If the second-opinion doc asks for specifics, just say that your insurance company encourages confirmation of findings (which is true of most companies, since in the long run it saves them money), and you're following through. Don't verbalize doubts about the first doctor - stick with neutral questions, i.e. "Are there any tests or procedures that you think would be useful?" Offer information in a detached manner, stating that you realize insurance companies don't usually reimburse duplicate studies, and you have previous test/imaging results in your possession, if he/she would like to see them.

    It's very frustrating for patients with SCI, because one look at us and doctors tend to default to standardized perceptions. I run into this quite often with MS, because it can look like so many other things and it's easier - and more cost-effective - for professionals to assume health issues are all related in some way to what's obvious. Our health care system (assuming you're in the US) is broken and benefits neither patient nor doctor.
    MS with cervical and thoracic cord lesions

  5. #5
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    Quote Originally Posted by Bonnette View Post
    I think it's safe to say that doctors come from a very defensive position nowadays, due to restrictions imposed on them by insurance companies and an increase in patient litigation. In the situation you describe, I'd go with very impersonal languaging - something like: "I came to see you because I need to make some treatment decisions, and want to be sure I have the fullest possible picture before I commit to a course of action." Steer clear of criticism of the other doctor or questioning his/her methods and conclusions. If the second-opinion doc asks for specifics, just say that your insurance company encourages confirmation of findings (which is true of most companies, since in the long run it saves them money), and you're following through. Don't verbalize doubts about the first doctor - stick with neutral questions, i.e. "Are there any tests or procedures that you think would be useful?" Offer information in a detached manner, stating that you realize insurance companies don't usually reimburse duplicate studies, and you have previous test/imaging results in your possession, if he/she would like to see them.

    It's very frustrating for patients with SCI, because one look at us and doctors tend to default to standardized perceptions. I run into this quite often with MS, because it can look like so many other things and it's easier - and more cost-effective - for professionals to assume health issues are all related in some way to what's obvious. Our health care system (assuming you're in the US) is broken and benefits neither patient nor doctor.
    Very well put, accurate and to the point. Perfect way to handle the situation. I tried to reply but cancelled it due to my experiences made it too negative.
    Attack life, it's going to kill you anyway
    Steve Mcqueen (Mr Cool)

  6. #6
    I agree that it's important not to be negative about past physicians seen. However, just the fact that you have seen one or more in the past for the problem you are now in front of them for often leads to negative stereotypes on the part of the MD you are now dealing with.

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