“Request consultation or ‘second opinion’ before the patient or family does.”
-Joseph Mallach, MD
Faculty, Northwestern Med, 1966
I would suggest an additional step when faced with a very difficult diagnostic situation, unanticipated post-operative difficulties, or a frank complication or untoward result: “Request consultation or ‘second opinion’ before the patient or family does.”
That savvy advice was given to me as a senior medical student and it has served me and my patients very well for nearly 50 years. When the sailing is not smooth, that is the time to seek further advice/opinion. Good for the patient which is paramount. Also, head off a potential legal problem earlier rather than later.
The patient and/or family is advised that “I believe two heads are better than one; perhaps a very experienced colleague can help us along the way”. Would anyone argue with that?
Important: There should not be an additional expense to the patient for this consultation; when things are not going well, additional out-of-pocket costs will not sit well with the patient and/or family. If there is not proper insurance coverage for such second opinions, either ask a trusted colleague to waive his or her consultation fee or even offer to pay the colleague/ consultant for his services( none has ever taken us up on that offer). Patients are quite relieved to hear from the consultant that “It is my pleasure to assist Dr. ______ in helping you. There is no out-of-pocket charge to you for my services”.
Patient and family respect for you will only be enhanced by your gesture of humility and generosity. They will rightly see you as a valued ally and friend.
Try it. The time and — if spent — money are always less than that spent with attorneys after the fact; guaranteed.
Robert Kotler, MD, FACS
Clinical Instructor
Department of Head and Neck Surgery, UCLA