Lockup Doc

A few months ago I performed an inpatient consultation on a non-incarcerated patient. His psychiatric care was being managed by a neurologist in another community.

I was shocked and disappointed when his family informed me that the neurologist told them that if the patient sought a medical opinion elsewhere, the neurologist would no longer treat the patient.

Even on a bad day I cannot fathom exuding such arrogance and insecurity! Hopefully this doctor’s attitude about second opinions is the exception and not the rule among physicians. However, this situation sparked my curiosity about second opinions.

Throughout my career, I’ve often encouraged my patients to obtain second opinions, either when they have questioned my diagnoses or treatments or when I have given them serious diagnoses such as schizophrenia.

In other situations I have specifically arranged for them to see trusted colleagues for second opinions when I have been clinically perplexed or have needed another psychiatrist’s input for risk management purposes.

In correctional work it tends to occur more in the context of risk management. For example, if an inmate strongly disagrees with the treatment I am providing, having him see another psychiatrist lends credibility to my treatment and helps to protect me legally if he tries to initiate legal action.

Interestingly, regardless of treatment setting, I’ve never had a patient see another psychiatrist for a second opinion and decide not continue his or her treatment with me. I don’t think that the reason has anything to do with my having superior knowledge or treatment approaches. I would bet it is due to the fact that I honestly try to collaborate with patients, and I’m not afraid to say, “I don’t know.”

Until now, I really hadn’t thought much about if, when, and how often other physicians, regardless of specialty, request second opinions on their own patients.

If you are a physician, do you ever request second opinions on your own patients? Under what circumstances? Do you ever try to discourage patients from obtaining second opinions?

If you are a patient, have you had any experiences, positive or negative, with second opinions that you would like to share?