Patients Should Always Get a Second Opinion after Seeing Dr. Google

I am all for patients educating themselves on their health. I think well-informed patients mean a much better chance of taking better care of themselves. After all, we can’t expect a patient to do what we want him to do unless he knows what that is. I also believe that patients have the right to accept or decline care, so long as that decision is based on accurate information. We are all taught about informed consent; I think we need to accept informed rejection.

Having said that, there’s a whole lot of information out there; and a whole lot of misinformation. Sometimes, all the patient has seen is an ad for a law firm. There are bloggers out there who either don’t know how to read clinical studies or intentionally quote phrases out of context, yet patients will take their word as gospel truth. There are websites dedicated to certain health conditions, but the content is mostly anecdotes and opinion.

I have patients come armed with pages that they printed from a website or with a book by some celebrity author. I am tempted to say, "You know what I found on the Internet? There are aliens that walk among us." But I don’t. When I try to explain what current science says, they retort, "But I’ve read so much!" Yeah, like I don’t read anything. Four years of pre-med, four years of med school, three years of residency, two years of fellowship, 12 years of practice during which I get a minimum 50 hours of CME a year, weekly and monthly journals, digital and print clinical updates, and I am supposed to be swayed by something Mrs. Jones found on Wikipedia?

Don’t get me wrong. I don’t claim to know all there is about medicine. I won’t claim to know all there is to know about endocrinology. But greater minds than mine come together to create guidelines and publish in peer-reviewed journals. Do they know all there is to know? Of course not. Some guidelines are based on expert opinion only, without evidence to back it up. And guidelines change as we learn new things. And do I do things sometimes that aren’t by the book? Sure. Sometimes you just need to make an exception. But by and large, decisions have to be made on solid scientific principle. It keeps patients safe from being experiments. "Do no harm."

I will often direct patients to websites like the Hormone Foundation. I give them handouts that explain their disorder. I try to dispel myths and to provide them with accurate information.

If, in the end, they continue to disagree with me, I tell them that they are adults and as long as they understand the potential consequences of their decision, I cannot force them to follow my recommendations. They are always free to look for a second opinion. If they insist on a test I think is unwarranted but safe, I caution them that it may not be covered by insurance and that I will not waste my time or that of my staff in getting it approved, but if they want it done I will order it. I will not, however, prescribe medications I think will be harmful to them. They can have whatever expert convinced them it is necessary prescribe it.

In a world where we can access information about almost anything while at the dinner table, it can be difficult to separate the wheat from the chaff. For patients’ sake, I wish there was a way to make it easier for patients to find the wheat.