Informal “Second Opinions” Can Be a Minefield

Friends and family members frequently ask me for advice or for my opinion of their medical care. This can be very difficult to untangle. Invariably, you are not there, looking at the patient. You don’t have all the information. You probably have affective bias regarding the patient. The patient may have misunderstood what happened or what they were told. Frequently the physician is of a different specialty, and you are rightfully concerned that you are out of your lane. As a physician, you wouldn’t appreciate outside meddling if the shoe was on the other foot. And yet, you may sense that something is not right.

A relative whose alcohol use disorder was an open secret within my family had refused treatment for decades. They presented to their long-term PCP with anxiety, tremors, abdominal pain, and vomiting. Unaware of the alcohol history, he diagnosed “diverticulitis and a UTI” and prescribed oral antibiotics. I found out from the spouse later that day. This was shocking to me.

What history was related? What were the vital signs? Was the patient tremulous? What was the abdominal exam? What did the doctor really say? It made my head want to explode.

This sounded to me like alcohol withdrawal, so ultimately, I told the spouse to bring them to an ED, where they were admitted to the hospital. COVID-19 protocols prohibited visitors, and the spouse had difficulty communicating with the treatment team by phone. As a physician, I had an easier time getting through. I made sure to inform the clinicians of the relevant history, and the proper diagnosis was made. For the first time ever, my relative went into an alcohol treatment program.

Strategies for Interacting with Loved Ones’ Physicians

The easiest scenario that you might encounter is when the patient is getting care within your own medical system. We all know doctors in whose hands we would place our lives and those in whose we would prefer not to do so. This inside information is invaluable.

With doctors you don’t already know, if possible, vet them before the first patient visit. Check out their credentials online and look in the state medical board’s website for complaints or disciplinary action. But this tells you only so much. I don’t usually look at patient review sites, but that probably reflects my bias about such things.