Sunday, November 3, 2013

Patient Advocacy: Facilitating A Second Opinion

Patient-advocates have the right contacts to be able to arrange for a second or third medical opinion for the patient
Your doctor drops a bombshell. He tells you that you have a very serious ailment. The news strikes you like a bolt from the blue. You feel worried, anxious, defeated and confused, until, your spouse, who is also concerned about your health, suggests you don’t take the doctor’s word as final and seek a second opinion. You immediately feel relaxed. In this case, your spouse has acted as your advocate.
One of my patients had an interesting experience to share, “I had a lump in my neck. It was causing some sinus issues. My doctor sent me for a CT scan and when the results came back, he told me that it was tumour and had to be removed right away. I felt shocked and unsure of what to do. I called my sister who suggested that I call her doctor, someone she had consulted all these years on all her medical issues and trusted completely. I sought an appointment with my sister’s doc. He asked to see my CT scan along with a few other lab reports. Armed with all those reports I landed at his office. He examined them and said what my doctor was calling a “tumour” was actually a benign growth and it had been there for at least one decade without changing in size or shape. He also said surgery was unnecessary. I felt massively relieved.” In this case, the patient’s sister played the advocacy role by providing timely advice.
Once, at a patients’ group meet, an elderly man in a wheelchair raised his frail, trembling hand and asked, “How do I know whether my doctor is giving me the right advice?”
He had a point. You can’t go by a single doctor’s advice about a serious condition - you need to have it cross-checked with another. After all, your time, money and life are at stake. Doctors, especially busy doctors, often rush into making a diagnostic pronouncement, without always dotting all the “i”s and crossing all the “t”s.

A “patient advocate” can be a God send in such scenarios. He could be a spouse, a friend, a
brother. Since a caregiver is generally a person on the “inside,” they are in a good position
to know and understand the needs of a loved one. She may not have the necessary medical
background, but her knowledge of the patient’s desires are equally important in making the
best medical decisions.
Banish the thought that a patient-advocate is an adversarial position. It doesn’t necessarily
mean being a doubting Thomas, and rushing out and getting a second opinion on every matter,
or logging on to the internet and conducting your own research and confronting a doctor
with your findings. It doesn’t also imply slipping on the boxing gloves and declaring, “Hey, I am
on the other side. So Beware!”
What it means is that you are careful and wise. You don’t doubt others, but you do crosscheck
important information. It means that even if you decide to do your own research or
obtain a second opinion, you will speak about this to your doctor. A good doctor should
appreciate your transparency and this will strengthen your relationship. Remember, effective
patient advocates do not breed discontent; they build long-lasting relationships between
patients and their doctors.
Physicians are bound by a code of medical ethics that directs them to co-operate fully with
their patients. If patients want to take a second or even a third opinion, doctors are legally
bound to share your lab reports, prescriptions, and test results with other physicians. A doctor
worth his salt would not feel insulted by such a suggestion. In fact, if your doctor discourages
you from seeking another opinion, you have every reason to suspect his motives – and this
should motivate you even more to seek another opinion. Generally, a patient-advocate will
advise a second opinion when:
You don’t have confidence in your doctor. Patients are less likely to follow a course of
treatment when it’s prescribed by a doctor whom they don’t trust.
You think there might be other treatment options. If your doctor tells you there is
only one course of action, it should raise a red flag.
Your doctor dismisses your concerns. You know your body best, and if your doctor
doesn’t listen to you or take your symptoms seriously, go see someone else.
You’re not getting better. Medicine is as much an art as a science, so a fresh viewpoint
might make all the difference if you’re not recovering from an illness or surgery at the pace
you expected.

You’re doctor recommends surgery. Anytime your doctor recommends an elective
surgery to correct such problems as back pain, cataracts, gall stones or hernia, consider a
second opinion.
Your condition is uncommon. Some conditions are so rare that a physician may have
seen only one or two such cases in her career. It’s worthwhile to consult a doctor at a major
medical centre who has more experience with dealing with rare diseases.

The above is an extract from Dr.Aniruddha Malpani's book : Patient Advocacy - Giving Voice to Patients
The book launch will take place on Saturday, 16 November 2013 at Hall of Harmony, Nehru Center, Worl, Mumbai - 400018 during the 4th Annual Putting Patients First Conference.

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