Saturday, May 12, 2018

Second opinions for IVF patients

While second opinions can be quite helpful in reducing " avoidable medical care" , they come with their own set of challenges. . Patients are scared about seeking out a second opinion because they are worried that by doing so, the doctor who is treating them will get offended and may disengage himself from the treatment. Patients are scared of physicians and don't want to risk antagonizing them!

The two sides of the coin

1. Not all second opinions are correct. Sometimes, it's the "first opinion" which might have been the right decision for the patient, and only time is able to tell which doctor was right. It's naive to simply assume that the second opinion was better than the first! Let's not forget that doctors who give second opinion are also often biased to giving one which is different from the first opinion – after all, doctors love playing a game of one-upmanship to show they are better than their colleagues! Second opinion services are incentivized to "adding value" to patients by providing a different perspective. Not surprisingly, a third opinion could be completely different!

2. Second opinions can aggravate the situation. It might be convenient to take a second opinion online, but this may end up leaving the patient confused and paralyzed into inactivity when the opinions differ. Who does he believe? The online anonymous doctor who has been positioned as being an expert? Or his personal doctor, who knows him and whom he can talk to face-to-face? Conflicting opinions may also cause him to lose trust in the medical profession in general, and in his doctor in particular. This erosion of trust is harmful for the patient, because if one cannot trust his/her doctor, it's harder for healing to take place.

3. The true value of a second opinion is realized not when it differs from the first opinion but rather when it agrees with it. This reassures the patient that he is on the right track, and it reinforces his confidence in his doctor.

Empowering the patient
There are few black and white areas in medicine. Considering there are multiple options available to both doctors and patients, the whole activity of seeking a second opinion should not degenerate into a doctor vs doctor game, driven by individual egos.
It's important to emphasize the key role the patient needs to adopt in making the final decision. It's not enough to just take a second opinion, and then leave the final decision to a doctor. A mature patient acknowledges that it's his responsibility to make the final call! The mantra in medicine today is “shared decision making,” and patients need to become expert, empowered, and engaged so that their voice is heard.
That doesn’t mean patients need to become medical experts! However, they do need to learn to use information therapy, which aids patients in making the right decision . Information Therapy provides patients with evidence-based guidelines, so that they can ask for the right medical treatment they need – no more and no less.

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