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Second Medical Opinion

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When access to medical consultation is as easy and cheap as is in India, that many patients, especially those with resources, would seek more than one expert’s opinion, is only to be expected.

“Second opinion” is the seeking of another medical opinion to verify or validate what the first doctor had diagnosed or advised, and is often quite a valuable step. if an otherwise healthy person who has had no symptoms of disease till yesterday, is suddenly told to have liver cirrhosis due to a viral infection that requires long and expensive treatment, it is imaginable that he and his family may like to verify the test results, explore if there are other management options, weigh the pros and cons, and particularly in our country, see if they can get the treatment at more affordable rates, before they decide to start.

The diagnosis of cancer is certainly is another such situation. It often comes as a shock and evokes a sense disbelief and denial in patients with thoughts like “it just can’t be true, I just had symptoms of indigestion” or “it cannot be happening to me”. A second evaluation by a competent doctor re-confirming the diagnosis helps the patient to accept the unpleasant truth.

Indeed, good physicians and surgeons often advise their patients to consult a second physician so as to get convinced of the unpleasant diagnosis and then return with greater motivation to embark on a treatment that is challenging.

It is here that Indian doctors often fare badly and irresponsibly: most end up contradicting the previous one with an attitude of one-upmanship, change the names of medicines in a fresh prescription, and try to “win over” and grab the patient rather than sending him back to the first one, leaving the patient more confused.

The line that divides “second opinion” from “medical shopping” is however a blurred one.

Medical shopping is quite akin to what we do while buying vegetables, going from one grocer to another enquiring the rates of cauliflowers, seeing their size, and at times bargaining, before making our purchase. There are people who in their contrived habit of seeking the cheapest will enquire about the cost of endoscopy in 5 centres before going in for one. It may not always be the price, but the popularity of the doctor or the market-stature of the clinic instead which could be the choice determinant.

Once a “noveau riche” businessman’s wife in her 40s, brought her 12 year old daughter, As I went through her history and scanned the results of the innumerable ultrasound and CT scan tests she had gone through, the mother proudly told me that she had consulted 18 of the top pediatricians, surgeons and gastroenterologists of the city.
She was obviously in a “number game”, trying to satisfy herself that she had not left any stone unturned, but was losing out on any caring doctor who would be willing to take a personal interest to solve the child’s problem, knowing he would be just the next one in her unending list!

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