The Second Opinion
I do recommend to patients that they consider a second medical opinion, especially if the correct diagnosis could be heralding something major, or even life or death. The most amusing second opinion I was asked to give was when I was working in the UK. It was a two doctor practice, with the senior being a delightful older doctor, who ran a private practice, which was very rare in those days, with the patient paying for consultations. As the second (and younger) doctor in the practice I looked after the National Health patients, who were seen with no charge at the point of service.
One morning, my senior colleague came to see me, which was a rather rare occurrence. Without sitting down he said, “I have Lady Ponsonby Smythe (not the real name) in my room with abdominal pains. She wants a second opinion. I say Cholecystitis.”
I did follow him back to his room and I did examine the upper class abdomen, and pronounced her condition was caused by Cholecystitis. My function being over, I went back to my own consulting room. However, I have often wondered what I would have done if I had disagreed with my senior doctor’s diagnosis?
Many of you have asked me over the years, “Why do doctors not treat their family but get another doctor to see the patient?” The best explanation I have ever heard came from a retired doctor in Queensland Australia. “If you don’t refer the family patient to another doctor, then you go to the samples cupboard to look for some suitable medication. When you can’t find some suitable tablets, then you change the diagnosis to suit the samples that you do have!”
I must admit that the above has happened to me with my children over the years. They have survived, and so have I.
When doctors go on holidays, most will employ a replacement (locum). This gives some sort of continuity while the principal is away. I too have done stints as a locum with the most memorable being in a sleepy rural practice in one of the UK’s counties.
I had just come from a 12 month contract in Gibraltar and saw that a locum position was being advertised in the British Medical Journal which I applied for. Asked to come for an interview I was walking down the driveway and met another young chap coming out. He asked if I was applying for the locum position and when I said I was he replied, “Hit ‘em high!” and walked away.
The interview panel seemed to favor me and they then asked what sort of salary did I expect. Remembering “Hit ‘em high” I quoted a figure much higher than usual. When they readily agreed I then added in fuel and accommodation and they agreed to that as well. The length of the time there was to be three months, so I was set.
I had been there about six weeks when I asked the staff where was the doctor I was standing in for? Embarrassed looks all round and didn’t I know about the principal? When they found I had been overseas for the previous 12 months they then told me the sordid story. I was standing in for a lady doctor who had been murdered on the golf course. Everybody in the village “knew” who the murderer was – a man who the doctor visited every Thursday morning. Unfortunately there wasn’t enough evidence to charge him, so the Thursday visits continued. I began to hate Thursday mornings, knocking timidly at the door to his flat and waving my stethoscope around the door before I entered.
It turned out that this was the reason for the “Hit ‘em high” as the English locums knew about this practice and the principals could not attract a locum. Being overseas I did not know. But then I came as a godsend for them!