A built-in second opinion?

It was my turn this weekend to cover for my colleagues in our internal medicine practice. It wasn't all that strenuous. One of the hardest things to do, however, is justify to a patient a decision that another doctor has made that I might not agree with. It is hard to reconcile the many contradictions inherent in such a disagreement. On the one hand, the knowledge that medicine involves a spectrum of truths; on the other, the conviction that many courses of action taken for granted in today's practice are mistaken - overuse of tests and procedures among the most common of them. There is the relationship between the patient and their primary care doctor which one is loath to interfere with, and then there is the need of the particular person at that time. Finally, there is the fact I referred to above: we are all in a practice, and so - to a greater or lesser extent - we share patients. Sometimes, it's a good thing for our care to be viewed by a different pair of eyes and addressed by a new set of assumptions. Isn't that what quality care is meant to be, if we agree with the assumption that it is quantifiable - an opportunity for someone to evaluate care at a clarifying distance?

Whenever a colleague of mine sees my patients, I hope they might see something I have not noticed before. Maybe every person who sees a doctor should be granted that opportunity with regularity: a built-in second opinion to make sure opportunities and dangers aren't missed.

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