When a patient asks for a second opinion

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In 1789, Benjamin Franklin is credited with the famous quote, "In this world, nothing is certain except death and taxes." For doctors, there's another certainty. "At some point in your practice career, you will be served with a malpractice lawsuit, and a patient will ask you to see another doctor for a second opinion.” This blog will discuss suggestions for managing patients who request a second opinion.

When a patient requests a second opinion, a doctor should respond with professionalism, support, and encouragement. This is not a time to be defensive or be oft-putting. Show the patient that you respect their right to make decisions about their care. Avoid being defensive or dismissive. Here are a few suggestions for managing the second opinion request.

Acknowledge the patient's request without taking it personally. Let the patient know that seeking a second opinion is a common practice and that it's important for them to feel confident in their healthcare decisions. An appropriate response might be, "I completely understand your desire for a second opinion. You must feel comfortable and confident with your decision to proceed with a treatment plan."

Offer to help facilitate the process of the patient receiving a second opinion. This can include recommending another specialist, providing a referral, or sharing medical records with the doctor to give a second opinion. It is a nice gesture to make copies of the patient's records and provide them to the patients or send them to the doctor the patient selects for a second opinion. There's a decision on whether to charge the patient for making copies of the records. It is not unreasonable to charge the patient for making copies. In the instances when I was asked for a copy of the records, I did not charge the patient. To avoid making multiple copies if the patient sought multiple opinions, Make a copy of the records for the patient, and the patient can share the records with as many physicians as they wished.

It is helpful to let the patient know that you are available to continue the discussion after they receive the second opinion. Emphasize that you are there for them regardless of their decision. Leave the door open for the patient to return by letting them know that you are interested in their well-being and are not abandoning the patient. This attitude fosters trust and maintains a relationship with the patient.

The practice of charging patients for copies of their medical records can depend on several factors, including local laws, healthcare regulations, and the policies of the specific medical practice. Here are some general considerations:

HIPAA (Health Insurance Portability and Accountability Act) in the U.S. allows healthcare providers to charge a "reasonable" fee for providing copies of medical records. However, this fee should only cover the cost of labor, supplies (e.g., paper or electronic media), and postage. Charging a patient an excessive fee could discourage them from obtaining their records and undermine their autonomy in seeking a second opinion or transferring care.

If records are stored electronically, providing a digital copy (e.g., via email or a secure portal) can often be done at a minimal cost. It would be appropriate to waive the fee for electronic copies because they are easier and cheaper to distribute.

Many doctors or healthcare institutions choose to provide a patient with their records free of charge to maintain a positive relationship, especially when the patient is seeking a second opinion. This gesture can maintain trust and show support for the patient's healthcare decisions.

It's important to balance the practice's administrative costs with the patient's right to access their own healthcare information. Charging an exorbitant fee could be seen as leaving a bad taste with the patient. It may be a steppingstone to litigation if there is a complication or other issue, like a delay in diagnosis.

When a patient asks for a second opinion, it can be appropriate and beneficial for the doctor to recommend other doctors or specialists. However, there are a few considerations the doctor should keep in mind when making recommendations:

The patient may already have a doctor or specialist in mind for a second opinion. The doctor should ask the patient if they have someone they would like to see before offering any recommendations. Suppose the patient needs a physician they want to see for a second opinion. In that case, the doctor should provide several suggestions rather than directing the patient to one individual. This respects the patient's autonomy while still being helpful. An example of a response: "Here are a few well-regarded specialists in this field. You can choose the one who feels like the best fit for you."

When recommending other doctors, the referring doctor should ensure that the specialists have the right expertise for the specific condition or issue. This ensures that the patient receives the most relevant and high-quality second opinion.

The doctor should explain why they recommend specialists, so the patient understands the rationale behind the suggestions. Transparency helps maintain trust and ensures the patient knows the recommendations are in their best interest. This avoids a conflict of interest if you are sending the patient to a colleague with whom you have a personal relationship.

Suppose the patient requests help with scheduling a second opinion. In that case, the doctor can offer to facilitate the referral, including sharing medical records with the recommended specialists. The second opinion becomes seamless if the referring doctor contacts the second opinion doctor and explains the medical circumstances and the reason for another opinion.

Bottom Line:

While a doctor does not recommend other physicians for a second opinion, doing so can be helpful and supportive, if it is done in a neutral, professional manner and with the patient's interest foremost in mind. Providing options and allowing the patient to make the final decision ensures that the process remains focused on the patient's needs and preferences. I hope you have found this blog on the second opinion useful and if you have any suggestions regarding managing the second opinion request, please let me hear from you, doctorwhiz@gmail.com.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.