Seeking second opinions encouraged as ‘normal’
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WAILEA, Hawaii — Respect for colleagues and for their role in the process is fundamental to providing second opinions, Jeffrey L. Goldberg, MD, PhD, told colleagues at Hawaiian Eye 2021.
Goldberg, who is professor and chair of ophthalmology at Byers Eye Institute at Stanford University, said he encourages patients to seek a second opinion.
He tells patients, “This is normal. It is the right thing to do,” and he offers to send the results of the second opinion to the first provider. Patients who perhaps do not like their first provider often decline this offer, he said.
“As providers we would never accept a diagnosis or recommendation for surgery without a second opinion, either from another clinician or our own research,” Goldberg said. “So, we should admit to ourselves that we are really accepting, in fact, and promoting the idea of second opinion to ourselves, to our family members, to our friends who are asking us. And it would be a strength of our profession to remember to do that for all the other patients, too.”
Goldberg said that when he senses that his patient is hesitant to accept his recommendation for surgery, he encourages them to seek a second opinion either at Stanford or in the community.
“If I can anticipate it, I can work that in before they’ve explicitly telegraphed that they are thinking about that second opinion and then you get bonus points for supporting that idea,” he said. More often than not, they decline the suggestion, he said.
There are two main goals of any second opinion visit – the correct diagnosis, which requires data about the patient, and building rapport with the patient, Goldberg said.
At the second opinion visit, Goldberg repeats a full data collection unless he has “personally approved from the lead tech showing me the referral a recent field or OCT is adequate quality.” He reviews the data before speaking to the patient.
When speaking to the second opinion patient, he makes a value judgement whether he wants them as a long-term patient or if he wants to simply provide them with the second opinion back to the first provider.
Goldberg tries to discover “what made this patient resist the first doctor’s recommendation for surgery.”
“Occasionally, of course, we know the recommendation outweighs the rapport,” Goldberg said. But no matter what, the second opinion provider must give the patient “a safe psychological escape for why they are choosing you [and your recommendation] and didn’t choose it last week.”
“It is how we treat our patients, but it is also how we treat each other that I think is really important,” Goldberg said.
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Goldberg JL. My approach to a second opinion visit. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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