I sometimes have patients who consult me for a second opinion on their medical condition. Conversely, I also know that a few of my own patients have sought second opinions from other doctors.
Before undergoing treatment, patients may sometimes seek a second opinion to confirm the diagnosis or to explore other treatment options. They may also seek a second opinion if their condition has not improved, or if they had suffered an adverse event while under the first doctor's treatment.
Much has been written about the benefits of patients seeking second opinions on their treatment. What is not often discussed, however, is how doctors actually feel about this practice.
When a patient consults me for a second opinion, I feel a sense of satisfaction that the patient is seeking my opinion for his/her difficult-to-solve medical problem. If I were to be honest, I sometimes get a sense of Schadenfreude knowing that the patient is seeking my help to make him/her better instead. But the truth is that as the second opinion doctor, I have the inherent advantage of hindsight, knowing which treatment did not work or already having a sense of what the patient feels about his/her proposed treatment.
I think there are few doctors who would be happy when their patients stop showing up at their clinic because they sought out a second opinion. In the early days of my private practice, I would get emotionally affected when my patients sought second opinions from other doctors. However, when other patients came to see me for second opinions, I realised that, like it or not, this is part and parcel of medical practice.
I have since come to accept that patients have the right to see whichever doctor they choose. Naturally, I hope that my patients who have gone on to seek second opinions understand that I had made my treatment recommendations or carried out treatment in their best interests.
At least one insurer in Singapore offers a complimentary second opinion for selected policy holders. A couple of clinics advertise second opinion services on their websites as well. A Today article in 2019 even extolled the benefits of getting a second opinion.1
While getting a second opinion can be helpful, I think it is unfortunate that when a patient seeks a second opinion, it usually means the abrupt end of one doctor-patient relationship, without proper closure. Perhaps a second opinion may not be needed if the patient has an open conversation with his/her doctor about his/her dissatisfaction and concerns, and allows the doctor to address them. Unfortunately, this does not happen often; many patients tend to shy away from engaging with their doctor and prefer to quietly seek second opinions.
I am happy with my recent experience with a patient who presented with a complex medical problem. I was upfront with the patient about the potential complications that may arise from treatment, and encouraged him to seek a second opinion – which he did. I felt that during the time I had the opportunity to treat him, we managed to establish a proper doctor-patient relationship that was more than transactional, and there was a sense of goodwill at the end of our last consultation.
We can treat our patients better by establishing trust, communicating well, having empathy and assisting in shared decision-making. This can minimise the need for our patients to seek a second opinion. And even if they still decide to seek a second opinion, the experience would probably be more gratifying for both our patients and us.