A middle-aged patient was to be operated for an abdominal condition by an eminent surgeon. In the past he had operated on hundreds of patients with similar conditions, but as with all good surgeons, he was conscious whether surgery could be avoided altogether. He was concerned with the risk of major surgery as well as the cost to the family in which the patient was the sole bread winner. The surgeon therefore sought a second opinion from a colleague who, while agreeing with the diagnosis, suggested a course of injections. The patient was not operated and was discharged after a few days recovery.
Obtaining a second opinion should indeed be a noble tradition of all medical consultants. The ultimate beneficiary would not only be the patient, but also the doctor himself. Doctors are not infallible and are bound to commit mistakes in managing patients. Other factors contributing to such deficiencies would be the heavy workload (not being able to spend sufficient time with the patient to arrive at the correct diagnosis), overindulgence in laboratory reports (which may be faulty) and lack of knowledge about recent advances in medicine. In such situations, what better course of action is there than a second opinion from a colleague?
Opinions are based on knowledge and practice. Doctors, in fact, whether voluntarily or involuntarily, are all the time utilizing knowledge obtained from opinions of others. Even in their formative years, most of the knowledge they acquire is based on opinion of their teachers (who themselves have obtained it from other sources) or from textbooks. Contemporary medical science has reached such dramatic heights based on opinion and hypothesis expressed by pioneering research workers and pharmaceutical manufacturers. Of course, these opinions are based on scientific facts and hypothesis and have been proved before application.
Senior consultants should not consider it infra dig to obtain a second opinion from a colleague, particularly a junior. Juniors are in fact, the ‘new brooms’ in the medical profession. Most of them are just after post-graduate examinations and are well versed in the theoretical and practical aspects of medicine. They may be conversant with the latest diagnostic procedures and methods of treatment and the seniors will certainly benefit from opinions expressed by them. This aspect is particularly applicable to the highly specialized areas of medicine such as cardiology, neurology, endocrinology and radiology. A senior consultant should never hesitate to obtain a second opinion from a junior who would be a highly competent cardiologist or a neurologist having being trained in a prestigious medical institution abroad. The junior consultant too should approach a senior colleague who is based on his long experience and skills andwould be able to provide a sound opinion. The patient too has a right to obtain a second opinion if he is not satisfied with the first or to doubly make sure that the first opinion was correct. However, he should know whom to go for the second opinion and the best person to advise would be his general practitioner.
Dr. Upali Illangasekera
Associate Professor of Medicine
University of Peradeniya