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On Call: Second Opinions

Thu, 09/24/2020 - 21:43

It is an inevitable aspect of life that people will disagree. You don't have to look far in the modern world to see signs of this everywhere, from relatively minor topics like the performance of sports teams to more substantial issues like racial equality. A distinct part of being human is having the opportunity to decide the foundation of what one believes and to build a house of convictions and choices upon it.

Yet beliefs by their very nature often conflict, and at those points where these conflicts occur, human beings are prone to standing their ground and refusing to consider the other point of view. This is obviously problematic in so many ways, but I'd like to focus on how these conflicts can shape your relationship with your doctor, and what you can do to navigate these occasions.

Not a week goes by when I don't have a patient encounter in which someone asks for my professional opinion about what ails them and we disagree to some degree about what that is. Generally, I do the best I can with the balance of my years of intense study, thousands of hours of hands-on experience, and usually some judicious review of medical literature to give an opinion that fits the facts as I see them.

To a patient with a minor cough and a sniffly nose and maybe a bit of a sore throat, I may say, "I think you have a viral illness. Drink plenty of fluids, take some Tylenol, and it should get better in a week or so." For many, this is enough information to comfort their fears and send them on their way.

But some people push back, and understandably so -- "I always get this bronchitis," they tell me, "every year about this time, and I always need an antibiotic to get better."

And so a conflict is born.

It may not be a major one. Almost always, it's one we can resolve without too much in the way of hurt feelings. I do my best to explain why I'm concerned about antibiotic resistance and the constellation of common findings in bacterial infection, and we come to some sort of an agreement regarding a plan.

Sometimes, though, we reach an impasse.

And this impasse isn't unique. Patients live in their bodies every day, and when a doctor tells them something that doesn't fit their lived experience, they understandably may want a second opinion or at least for their doctor to spend more time explaining his or her reasoning to them.

For the physician, this can be frustrating. We live in a world in which Facebook experts tell us that doctors are paid pansies for the pharmaceutical industry, where decreasing reimbursements lead to increasing pressures to see more patients in less time, and where the once-rock-solid foundation of medical and scientific evidence seems shakier every day. Given all of that, the thought of explaining every medical decision seems exhausting.

I say this not to excuse your doctor if he or she seems short when you ask for an explanation or say you'll seek a second opinion, but so you'll understand, hopefully, a little bit of what's going on in our heads.

I'm also writing this so that I do the same, so I remember that the patients who don't do what I ask aren't combative or stubborn, but human, and ultimately doing what they think is best. And I have to remember that many, many patients have had their experiences neglected by our flawed medical system. They may have asked for help for chronic abdominal pain for years, only to finally get the correct diagnosis of endometriosis, or they may have discussed their racing heart rate time and time again, been written off as anxious, only later to find out they had a thyroid issue. 

Ultimately, it's not that all patients are demanding or that all doctors are egotistical and don't listen. Like everything else in life, it's complicated, and sometimes patients are demanding despite evidence, and sometimes doctors are dismissive. I think the best way we can address this is to try to remember that everyone ultimately just wants to be healthy and to have their opinion be respected. As long as we keep that in mind, we can find a place for dialogue and empathy. Otherwise, these conflicts set up too many opportunities for further erosion of the doctor-patient relationship, and in a world defined by pandemics and fake news, that's just something we can't afford right now.
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Joshua Potter, D.O., is a physician with Stony Brook Southampton Hospital's Meeting House Lane Medical Practice who specializes in family and neuromusculoskeletal medicine. He oversees the practice's Shelter Island office. Opinions expressed in this column are his personal and professional views and not necessarily those of his employer.

 


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