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?