Doctors' Relationship With Second Opinions

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Doctors' Love/Hate Relationship With Second Opinions

Neil Chesanow Disclosures June 18, 2015

Opinions on Second Opinions Vary

Many if not most doctors would probably agree with Melissa Walton-Shirley, MD, a clinical cardiologist at Cardiology Associates in Glasgow, Kentucky, when she insists that "patients absolutely have a right to a second opinion." Dr Shirley did not qualify when a second opinion might or might not be justified.

But while many physicians say they agree with Dr Shirley, not all of them do.

"If a doctor is upset that a patient got a second opinion, I would consider that a knock," says John Mandrola, MD, a cardiac electrophysiologist at the Louisville Cardiology Group in Louisville, Kentucky. Dr Mandrola specializes in treating patients with atrial fibrillation, a condition for which patients commonly seek a second opinion regarding treatment. "I think it's a mark of a good physician that they don't get upset if a patient wants a second or third or even a fourth opinion."

But some physicians do get upset. Even Dr Mandrola sometimes does.

"It would be a little overconfident to say that I don't ever get emotionally attached to my recommendations," he admits. "But I am actively mindful of not being attached to what the patient chooses to do."

Not every doctor is always so mindful, however.

"I've seen situations where doctors who are threatened by second opinions might sometimes be the high-ticket guys," says Charles Davant, III, MD, a family physician in Rolling Rock, North Carolina. "The more money the doctor has at stake, the more likely they might be to lean toward doing something that would not be my first choice."

"I have rarely seen doctors get genuinely upset about patients who go for second opinions, says Ira H. Kirschenbaum, MD, chairman of the Department of Orthopaedics at Bronx-Lebanon Hospital Center in the Bronx, New York. In the rare event that a doctor does get upset, "I am sure there's ego involved: 'I spent time with this person. I thought we had a good rapport. Are they going to the other doctor because he marketed better?' People don't like to lose business."

"Physicians may interpret a patient's reluctance to follow their recommendations as a challenge to their expertise and authority," concedes internist Matthew H. Mintz, MD, associate professor of medicine at George Washington University Medical Center in Washington, DC. "But," he adds, "an open and honest discussion may lead to other, more likely causes, such as fear and denial on the part of the patient."

"There's certainly an ego component for some physicians," says emergency physician Miles Varn, MD, medical director of PinnacleCare, a health advisory firm in Baltimore, Maryland, "although what I tell the patients is: 'If a physician is really resisting a second opinion, there has be a reason for that,' and it's not necessarily a reason that's in the best interest of the patient. In our experience, we see very little resistance to second opinions."