Offering A Few Opinions On Post-Op Second Opinions

Author(s): 
By John H. McCord, DPM

Second opinions were easy when I started my practice 32 years ago. There was an ancient orthopedic surgeon (who also did gallbladders and hysterectomies). He always tried to steal my patients who came to him for a second opinion. The tremors in his hands tended to scare the patients back to me.

There were two young orthopedic surgeons who would say, “We can do a good job for you but McCord is as good as we are, but not better.” This mixed message always left them confused and they generally returned to me. There were no other podiatrists within 30 miles.

I have always told patients that second opinions do not hurt my feelings or offend me. I tell them this after we have discussed a proposed surgical procedure. In most cases, they do not seek a second opinion. Letting them know that I do not fear a second opinion builds confidence.

Now I have three other podiatrists in the community and six orthopedic surgeons. All of us are busy and none of us try to pirate away patients who come seeking a second opinion.

The most difficult second opinion is the postoperative type. A patient has seen one of my other colleagues, had a procedure and comes to see what went wrong. This is a time when my words and reactions can lead to legal problems for my colleague.
Patients who are seeking postoperative second opinions are often angry with the first doctor and ready to get a lawyer if I raise an eyebrow or make a negative comment about the first doctor. I want to help the patient find a solution but not a legal one.

Doctors who try to pirate away patients who are seeking a second opinion are on a slippery slope that can easily put them in court.
I had proposed a simple hammertoe operation to a 35-year-old man a few years ago. He let me know that he wanted a second opinion. He disappeared. The next I heard of him was from a malpractice attorney who wanted my help. The second opinion doctor told the patient he was better qualified than me and did the operation. Things did not go well for the patient. The toe ended up signaling for a left turn. The guy was mad and hired an attorney.   

I politely declined the request from the attorney and let him know that I had once tried to help his client but the fellow chose to go elsewhere. I thought but did not say, “And he deserved what he got.” I did call the other doctor and suggested he contemplate the ethics of stealing my patients who come to him for second opinions. The other doctor made some smart comment about his superior training and skills. I thought about calling the lawyer back but decided against it.

When a second procedure is needed to salvage a bad result, I encourage the patient to return to his or her first doctor. If the patient does not want to do this, I attempt to refer him or her to another skillful surgeon. I am okay with repairing my own bad results but uneasy about working on another doctor’s patient when the patient has come to me for an objective opinion.

I remember making a negative comment to a patient about a failed bunionectomy. She presented in my office as a new patient for treatment of another problem. I observed that she had a severe bunion on one foot that had a surgical scar across the top of the first MPJ. I said, “My God! Who operated on your bunion? You should demand your money back.”

The patient looked up at me and said, “Doctor, you did 15 years ago.” I had been talking loud enough that my staff heard the exchange. I heard muffled laughter for a few minutes. I apologized to the patient for my comment and for the bad result. I offered to do a repair without cost. She said, “What for? It feels fine.” I learn some lessons the hard way.

When I flat out disagree with another doctor’s care plan, I ask the patient if I can talk with the other doctor. I call the other doctor and express my concerns. Usually my colleagues are willing to engage in meaningful discussions. When they are not, I let the patient know that we cannot agree and give my opinion with the suggestion that a third opinion might be in the patient’s best interest.

I hated it when I was a young podiatrist and the old orthopod would steal my patients. I confronted him about it one day and his reply was, “Steal some of mine.” I did.

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