* * Anonymous Doc

Tuesday, February 8, 2011

"I'm coming to the clinic for a second opinion."

"A second opinion about what?"

"I think you should have to figure that out."

"I'm sorry-- what?"

"I don't want to influence what you're going to say. So I don't want to tell you what the other doctor said was wrong with me."

"I'm not going to be influenced by what another doctor said. I just want to know what your symptoms are-- what's the problem you're looking for a second opinion on?"

"I'm not telling you."

"I can't do anything for you if you don't tell me what's wrong."

"So I'm fine?"

"I don't know if you're fine. I haven't even examined you."

"But you don't think I need an antibiotic."

"An antibiotic for what?"

"I'm not telling you."

"I have no idea if you need an antibiotic or not. I don't know anything about you. If you want me to examine you, I need you to tell me what's bringing you to the doctor."

"I told you, I need a second opinion."

"About what?"

"I'm not going to make it that easy."

"I'm sorry, this isn't a guessing game. You're only hurting your own care if you don't tell me what the problem is."

"I don't think it's anything."

"What did the other doctor think it was?"

"I told you, I don't want you to be influenced."

"I'm not going to be influenced."

"I'll only tell you if guess."

"I'm not trying to play a game. There are patients in the waiting room. I'm just going to start examining you. Can I listen to your chest?"

"Getting warmer."

"This isn't a game."

"Come on, you're almost there."

"Is it your heart?"


"Is it your lungs?"

"I don't know."

"Can you take a deep breath?"


"Is that the problem?"

"I don't know."

"Are you coughing?"

"I don't know."

"I give up."

"Come on."

"Please just tell me what's wrong."

"Fine. I have a rash on my penis."

"And how was I getting warmer when I listened to your chest?"

"They're, like, sort of near each other. Right?"

"Is that a question?"

"Do I need antibiotics?"

"I don't know-- I haven't even taken a look."

"No, I'm not showing it to you."


"Forget it, I thought doctors were supposed to know things."



  2. Gotta love the human race.

  3. Many of the things you've posted were craziness on the patient's part. Not this time. You have someone who's heard that doctors can be influenced by someone else's diagnosis; he wanted to avoid that. All you needed to do was provide a little education instead of giving the patient the run-around.

    Patient: "I don't want to influence what you're going to say. So I don't want to tell you what the other doctor said was wrong with me."

    You: Getting a second opinion can be a good idea. What that means is that the second doctor is given all the information that the first doctor had, but not the diagnosis.

    Patient: What? No. I don't want you to be influenced.

    You: Think of it like taking a test in school. The teacher passes out a test to all the students, and everyone writes down their answers. Imagine if the teacher gave one student all the questions, but gave another student a blank piece of paper and told the student that in addition to giving all the right answers, first the student had to guess what the questions were.

    If you won't tell me what your symptoms are, that's like making a student guess the test questions as well as the answers.

    The second doctor, whether me or someone else, needs all the information you gave the first doctor. What's wrong? How long has this been going on? Does anything make it better or worse? Those kinds of things. The second doctor needs it all - but not the first doctors diagnosis. Then the second doctor will think about your symptoms, do an examination, and maybe order some tests. Based on all that information, the second doctor will make a diagnosis independent of knowing what the first doctor was thinking. If you think of it like that old school test, I get to have the same test questions as the other person; I just don't get to peak at their answer sheet.

    The thing that makes it a second opinion is that the second doctor considers all the information that the first doctor did and comes up with his own idea of what might be wrong.

    (discuss symptoms, perform exam... If you decide to order tests:

    Given what you've told me, and what I found on examination, here's the tests I'd like to order _____.

    It can be a good idea not to tell the second doctor up front which tests the first doctor ordered, because that can provide a hint to what the first doctor was thinking about. After a decision has been made to order tests, though, if it's the same tests that the first doctor ordered, you can save time and money by providing a copy of those test results. Sometimes with things like CT or MRI, the specific type of equipment used can make a difference, so it's possible that some tests might need to be done again on a different machine. Often, though, you can expidite matters by by just giving the second doctor a copy of the test results from the first doctor.

    You are welcome to take the time to have these tests done, but if any of them were already done for your first doctor, you can save money by just giving me a copy of the results. The fact that the other doctor ordered these tests won't influence my thinking because I've already decided to order them.

    Patient: Thank you for taking the time to explain that to me. I misunderstood what a second opinion meant. That makes so much sense...
    (okay, maybe not that last part)

    You blew an opportunity to help that patient, and all future doctors that patient might come in contact with.

  4. yeah, right. i seriously doubt that is the way it would have worked out.

  5. Apparently Warm Socks missed the lecture about letting the patient do the talking.

  6. Wait, who's on first, antibiotics on second, jack a$$ on third, what's on home?

    The stupidity it hurts.

  7. Warm Socks, are you serious??? What a waste of time. Hot and cold?? For real? I can see why you get so frustrated, Anon. No way that guy was going to make that easy. He didn't want the first diagnosis he was given (sounds like an STD, huh?) so maybe he figured he would harass you until you kicked him out and he could feel no guilt about skipping the antibiotic. What an ass.

  8. Is there anything to keep you from saying "Well, thanks for stopping by, call if you have any serious problems"?

  9. @Warmsocks: wow, congrats if you can spin out that calm, thought-out 10 minute lecture when you're put on the spot with a patient right there in front of you.

    IMO, this part: "I'm not going to be influenced by what another doctor said. I just want to know what your symptoms are-- what's the problem you're looking for a second opinion on?" should have cut right through all the silliness. Too bad the patient was so hell-bent on playing his guessing game.

  10. Patient came in asking for a second opinion, but left without one. In fact, left not even knowing what a second opinion is. I seriously doubt the patient would have needed the entire two-minute explaination. One or two examples is usually sufficient for teaching anything. Instead, he got nothing but the run-around.

    The doctor... now, let's see... did he help the patient? Did he explain anything to the patient? Did he make the patient better? Did he make the patient feel understood? Did he make use of this teaching opportunity? Did this patient encounter give him that satisfied feeling of knowing he'd done his job well?

    Nobody thinks they're going to be influenced. The fact is, doctors are influenced by what other doctors have said about patients. Claiming that you won't be influenced doesn't sound reassuring. It sounds like you're brushing off someone's legitimate concerns, and that you're too egotistical to believe you could possibly fall prey to such a thing.

    Then again, I could be wrong. Patients might not be qualified to provide insight into how doctors come across. Residents and med students might be in the best position to interpret how they're perceived by patients.

  11. Warmsocks, that analogy about "making the student guess the test questions as well as the answers" is just awesome!!