Patient as a Teacher for his Doctor

There is no doubt that the one person who will look after his own interests the best is the patient himself. You need to do your homework thoroughly, find out more about your problem, and then discuss the results of your research with your doctor. This is your right and your responsibility as well! Every honest doctor will agree that his patients are his best teachers!

When you play the Role of a Financial Manager

Medical treatment can be very expensive these days, and you must make it a point to know the costs involved. Many patients are hesitant to talk to their doctor about money matters, but this reluctance can prove to be very costly! Also, if you are claiming reimbursement (either from an insurance company or from your employer) you must make sure that you have complete records of payments made along with their receipts.

When you play the Role of a Medical Record Keeper

You must keep all your records safely, and this can be very helpful especially if you have a complex problem a chronic disease, or need to change doctors or get a second opinion. File all your records in reverse chronological order; and number all your documents in sequences. Also prepare a one-page summary sheet of your medical experiences. Software packages are available nowadays, which help you document all medical details very efficiently.

When you play the Role of a Treatment Decision Maker

You will have to decide which treatment to choose among the alternatives. Sometimes the choices are straightforward, but sometimes they can be very confusing. A good doctor will offer you all the options and help you to decide, but ultimately, you have to exercise your right (and responsibility!) to select a course of treatment. You cannot afford to leave everything to god, or to the doctor either!

When you play the Role of a Medical Information Researcher

The more knowledgeable you are about your problem and its treatment, the better are your chances of getting the right treatment. Educate yourself: you need to become an informed participant in your medical care in order to ask the right questions and to participate in making decisions about your treatment. This step will also help you to critically assess media reports about 'new breakthroughs in medical treatment', and whether these 'breakthroughs' are relevant to your problem or not.

Your role as a Patient

While you obviously have a vital interest in your medical treatment, unfortunately, you lack the specialized medical knowledge and skills to be able to take decisions in this context alone. This is why the concept of a team - which consists of you and your doctor, becomes very important. As a patient, your responsibilities are wide and varied. And you'll need to play several "roles" at various times.

The Ideal Doctor's Code of Practice

The People's Medical Society in the USA encourages doctors to display the following code of practice in their clinics. This code comprises are excellent guidelines for all doctors to follow, and you might consider sharing it with your doctor!

The code runs as follows:

I will assist you in finding information resources, support groups and health care providers to help you maintain and improve your health. When you seek care for specific problems, I will abide by the following code of practice:

1. I will post or provide a printed schedule of my fees for office visits, procedures, testing and surgery, and provide itemized bills.
2. I will provide certain hours each week when I will be available for non-emergency telephone consultations.
3. I will schedule appointments to allow the necessary time to see you with minimal waiting. I will promptly return your phone calls and inform you if your test results.
4. I will allow and encourage you to bring a friend or relative into the examining room with you.
5. I will facilitate your getting your medical and hospital records, and will provide you with copies of your test results.
6. I will let you know your prognosis; including whether your condition is terminal or will cause disability or pain, and will explain why I believe further diagnostic activity or treatment is necessary.
7. I will discuss diagnostic, treatment and medication options for your particular problem with you (including the option of no treatment) and describe in understandable terms the risk of each alternative, the chances of success, the possibility of pain, the effect on your functioning, the number of visits each would entail and the cost of each alternative.
8. I will describe my qualifications to perform the proposed diagnostic measures or treatments.
9. I will let you know of organizations, support groups, and medical and lay publications that can assist you in understanding, monitoring and treating your problem.
10. I will not proceed until you are satisfied that you understand the benefits and risks of each alternative and I have your agreement on a particular course of action.

Be Careful

Remember you have only one life, and you may not get a second chance to rectify a medical mishap. Many patients (or their relatives) who are victims of adverse medical outcomes, later regret not consulting another doctor, but by then the damage has already been done! The best method is to avoid a problem in the first place - by getting a second opinion!

Important point to be noted

An important point to be noted is that a second opinion should be sought under certain circumstances:

* If surgery is recommended. About 80 per cent of all surgery is elective (i.e., performed on a non-emergency basis). Recent studies have shown that one out of five operations is not really required -- what is considered 'unnecessary surgery.' A second opinion can definitely prevent you from becoming an unsuspecting victim of an overenthusiastic surgeon's knife!
* If the diagnosis reveals a rare, potentially fatal, or disabling disease. The original diagnosis could be incorrect and may need to be revised. Or, even if it is correct, there may be new or experimental treatments available at an institution specializing in the treatment of such a disease.
* If your symptoms persist unrelieved and the doctor can provide no satisfactory explanation for them.
* If the risks and benefits of the proposed procedures are not satisfactorily explained. The patient has a right to know the details about risks and the cost involved and the potential benefits of any procedure, test or surgery. It is preferable to get the relevant details in writing, so that you can digest them at leisure.
* If the diagnostic procedures seem unnecessarily complex or expensive, or both. Some doctors are prone to making excessive use of technology in borderline situations, either due to insecurity or to protect themselves against malpractice litigation.
* If the patient lacks confidence in the doctor's ability to do all that can reasonably be done. Effective treatment demands trust, and a lack of trust is as valid a reason as any other for getting a second opinion.

Other Sources for a Second opinion

You should also keep in mind that there are other ways of getting a 'second opinion' apart from going to another doctor. Presently, many sources of information can be tapped to verify and countercheck your doctor's opinion; for instance, health books and encyclopedias (all of which are available free at the Health Education Library for People, Bombay) as well as the Internet! For example, you can "Ask the Doctor" at www.flora.org/ask-doctor/, a free site which forwards your medical queries to specialists from all over the world, who then give their respective opinions on your problem.
You can also log in to our website – www.healthlibrary.com for any health related queries.

Second opinion from an Alternative Medicine specialist

Remember that it is also possible to get a second opinion from a doctor who practices alternative medicine, for example, homoeopathy or ayurveda. Such an opinion will provide a completely different perspective of looking at a problem, and you may prefer this alternative.

Excellent source for a Second opinion

An excellent source for getting an objective second opinion is the medical faculty of public hospitals - government or municipal. This source, unfortunately, has been grossly underused. The staff members here are basically academicians. Since they teach medical students and residents, they are usually well read and well informed. Moreover, since they do not have a financial stake in providing you with advice, their information is likely to be reliable and accurate. Of course, this procedure does involve the bother of waiting for a long time to get to see the doctor, but this wait is often well worth the effort!

What to tell and what not to tell your second doctor?

A crucial question is: Should you let the expert know your first doctor's opinion? Many patients do not tell the specialist that they have already consulted another doctor, because they want an unbiased opinion. However, most doctors do not appreciate patients who play games with them. It's far better to be forthright and explain to the expert that you are looking for a second opinion, so that he can explain the pros and cons of all the available options.

Looking for a Second opinion, but where?

Keeping all the foregoing factors in mind, the question then arises: From whom should you get a second opinion? You should seek a second opinion from an expert who has the courage to give you an unbiased independent conclusion. Such an expert would, obviously be difficult to find, but it's well worth searching for him!

Take a second opinion for Yourself!

However, by getting a second opinion, patients should realize that they are not casting aspersions on a doctor's competence or judgment, but are rather adopting a responsible attitude towards their own health and well-being. All patients have a right to seek a second opinion, and certain circumstances may arise in which it would be appropriate, if not mandatory, for them to exercise this right.

Anxiety for a Second opinion

Many patients also worry about getting a second opinion on their own accord. For one, they are apprehensive that if their first doctor were to find out that they have gone in for a second opinion, he may be offended. Another source of anxiety is the confusion that would result if they get differing opinions; they are worried they would not know what to do when confronted with such a situation. Most patients are quite passive and they tacitly feel that it much easier to trust their doctor and do whatever he suggests, rather than go through the trouble of getting a second opinion.

Dr.Malpani says:

I always encourage my patients to get a second opinion. As I explain to them: If two different doctors happen to reach the same conclusion, at least you know you are on the right track! However, don't always assume that just because the opinions of both doctors are identical, you are safe. For example, if you have angina and you consult a cardiac surgeon, there is a high likelihood that he will advise you to undergo bypass surgery. A second cardiac surgeon is also likely to recommend the same; after all, it's just simple financial common sense from the surgeons' viewpoint! Therefore, getting a second opinion from a non-surgical specialist (in this case, a cardiologist) can be helpful in preventing unnecessary surgery.

Consulting a second doctor individually

It may be difficult to get an unbiased opinion from a second doctor who is a member of the staff in the same hospital as your doctor. If at all possible, you should consult an independent doctor in another hospital for a second opinion. Most medical insurance policies that cover consultation fees will pay for this. In case of disagreement between two specialists, a third opinion could prove helpful. In the present age of the telecommunication revolution, the 'magic' of telemedicine enables one to get a second opinion from a leading medical authority in any part of the world. The procedure usually consists of sending such an authority your clinical findings and medical reports through the Internet, so that you can get an unbiased opinion usually in as short a period as two days. Many clinics in India now offer this service in collaboration with leading hospitals from all over the world.

Second Opinion: Needed for Patient or Gain for Doctor?

Often, many patients tend to become sceptical or dissatisfied if their doctor suggests that they seek a second opinion, because they feel that such a suggestion indicates that their doctor is not competent. However, one should not forget that medicine is a highly complex science in which rapid advances are the order of the day and it is not humanly possible for one doctor to keep abreast of all developments in all fields. Consequently, a second opinion proves very useful for those patients afflicted with rare or complex problems. Unfortunately, some doctors tend to refer patients unnecessarily to other members of their fraternity. Also, doctors will often cross refer patients to each other for personal financial gain. In hospitals, especially, specialist consultation is often automatic and mandatory, and this process is inevitably overused. The upshot is that the patients’ bill shoots up! Thus, a hospitalized patient should ask the family physician (who should act as your medical manager) to intervene if the number of specialists involved in the treatment seems excessive.

Second Opinion

At present, getting a second opinion has become a common practice among doctors; in fact, the American Medical Association advises that 'physicians should seek consultation upon request; and in doubtful or difficult cases'. That is why family physicians often consult with specialists, and specialists, in turn, consult other specialists - and superspecialists. (Sometimes, though, the process could be misused, and the patient may feel that he is stuck on a non-stop merry-go-round of consulting a wide variety of specialists!)