The second opinion

Dr. W.B. Wijekoon

The denial to a patient of a second opinion, either when requested by the patient, his relations, or by the attending Consultant's own free will, amount in my opinion, to the denial of a basic Human Right of the patient. Thus, it becomes a serious lapse on the part of the medical attendant.

A doctor attending to a patient. File Photo

No doctor can claim to be the sole authority on any clinical problem and no doctor is considered indispensable. This is a basic fundamental fact that all medical specialists should always bear in mind. Hence, the granting of a second opinion on request of a patient, his relations or on consultant's own volition is an honourable act, and should never be withheld. A second opinion is, moreover, highly desirable as the consultant can always share the blame if, in spite of the second opinion, the patient's condition deteriorates and ends in death.

A second opinion is always given by another consultant only on request. Never by any other means.

Let me relate a few instances in Sri Lanka where the second opinion was sought without the knowledge or consent of the attending consultant and the disastrous consequences of such unethical acts.

This first incident occurred when we were medical students (1959-1964).

There were two well known consultants, one was tall, handsome and very hot tempered and the other was short, dark and mild mannered. The former consultant was treating a fellow medical student's father in a well-known private hospital in Colombo-7.

This anxious medical student had sought the advice and intervention of the latter consultant, who had visited the hospital and was in the process of examining the patient when, in walks the tall, consultant. He simply pulled the bed head ticket from the short consultant, dashed it on the floor, and landed a thundering slap on the face of the short 'unethical' consultant, and chased him out of the hospital. That was the end of the second opinion of the short consultant!

The second incident occurred when I was a consultant and here too a Head of State was involved in a different context.

The then Municipal Commissioner was under my care at a private hospital in Colombo. The patient was quite satisfied with my treatment. He happened to be a very good buddy of the then President, R. Premadasa.

At that time there was a consultant who had left Sri Lanka for the States and used to visit Sri Lanka on an off to throw his weight about and 'Show off'. The President had requested this 'foreign doctor' to see my patient. I saw this 'foreign body' examining my patient.

To avoid a confrontation I refused to walk into my patient's room and left a message to my patient with the ward sister and walked off. That same night the patient telephoned me home and these were his words: "Sir, mata samawenna, mey lokkage moda wedak, kohedo yana waathayak evala maava balanna, Mata Sir thamai ona. Karunaakarala heta sitan mava baraganna'.

After that I took charge of my patient after insisting that the 'unethical foreign body, should write an apology on the bed-head ticket, which he ultimately did. I cannot blame the President because he was completely clueless as regards ethics and etiquette, but the so-called foreign consultant should have known better to at least ask me over the telephone before gatecrashing on my friend.

This third incident is very unusual and freakish. A young up and coming consultant was treating a patient (an ex-cricket captain of St. Joseph's College, Colombo) at a leading private hospital in Colombo in the late 1980s. The patient was a good 'boozer' and had obscure fever. As the patient was going downhill daily, the relatives of the patient had wanted a second opinion from me and had requested the attending consultant to summon me, for advice.

He had flatly refused, and scolded the relatives for raising such an idea. The patient continued to deteriorate. The 'cocky' consultant was carrying on regardless, trying every antibiotic on earth, without attempting to properly diagnose the patient's illness viz. the cause for the fever. Repeated requests to summon me were rudely dismissed. Then the inevitable happened. The patient was from Kotahena area.

A couple of thugs were sent to the consultant's house and they have told him in a rich language to either summon me immediately or face the consequences which, of course, became obvious to this consultant who was stubborn till that moment. He had immediately proceeded to the patient's bedside and written a 'nice' letter to me to see and advice! The patient had a liver abscess, which was drained b a surgeon summoned by me and he recovered completely, thanks to the thugs!

The last incident I wish to report pertains to my own young, brilliant Registrar (who is now a Professor of Medicine) and his ailing doctor father. One night at about 9 p.m. my Registrar telephoned me and said that he wished to show his father to me who has had a fainting attack that evening at his home. I volunteered to immediately visit his home about 10km away from my home.

My Registrar, however, did not hear of it and said that he will bring his father along to my residence. I examined the patient thoroughly and wished him to be taken to the Intensive Care Unit of the National Hospital, for observation and monitoring. I also said that I will be following him soon, to the ICU for a second look at him. Once in the ICU during the short interval of approximately one hour before my arrival on the scene, my Registrar's mother had telephoned another consultant (A family friend of theirs) who also happened to be short and requested him to come to ICU and see the patient.

The consultant friend had found out that I had been consulted and my instructions given etc. He had most diplomatically opted out of the scene quite rightly too because I am sure he would have been well aware of the slapping incident of the past! Thus a repeat 'slapping episode' was diplomatically avoided by that thoughtful consultant.

My registrar long years later unfolded the happenings that night at the ICU prior to my arrival on the scene. His father is quite well today!

These episodes are instances where there was glaring abuse of the second opinion and the drastic consequences thereof.

A second opinion should always be granted with the full consent of the patient and the attending consultant.

It is always advisable and desirable to summon a well-balanced, well-trusted, gentlemanly consultant for second opinion. If the wrong choice is made for the second opinion, he or she might appear on the scene and try to score a point or two at the expense of the attending consultant. Thus one has to be doubly cautious in deciding on the person from whom the second opinion is sought.

If the above mentioned criteria are followed by consultants when dealing with their patients who may need a second opinion in life threatening conditions affecting them, both patient and consultant should be happy and contented with the outcome.