Eminent physician speaks on importance of medical second opinion. Doctor should be able to say: I don’t know. 6
Many patients think they are getting the best diagnosis and treatment. Patients have good health insurance. Or they live in a country where the state covers cost of health care. Maybe a patient lives next to a large academic hospital. But in reality patients might not get the best medical care for their specific situation. A diagnosis could be incomplete or imprecise, even though it is generally correct. A much better treatment methods or a more suitable therapeutic strategy might be available somewhere else. This is what happened to my mother, when she had a lung tumor diagnosed. It turned out to be a rare lung tumor. Dr. Marshall Wolf, MD. The initial medical plan was this. “Elderly lady, nothing to do”. It proved *not* to be the best course of action. It took a very detailed medical literature search. It took a global medical network consultation to find another physician. That expert was similarly experienced. He worked next door to the first doctor. New expert looked at the CT scan and said, “Look, we will do a couple of tests, and we can proceed to surgery immediately. Then she will not need chemotherapy or radiotherapy”. That was several years ago and it worked! Is she doing well? Dr. Anton Titov, MD. Yes, my mother is doing well. It worked well, and it prompted me to start this interview project. Because so many people are not getting the precise diagnosis and the best treatment. Because they don’t probe their medical problem further. Patients often cannot probe further to find best diagnosis and treatment for them. How can patients make sure that they are getting precise diagnosis and best treatment? Dr. Anton Titov, MD. What do you think of patient-initiated efforts to seek a second opinion? Dr. Anton Titov, MD. Should patients seek other medical expert opinion in difficult medical situations? Dr. Anton Titov, MD. Okay, well, two things. You know Ted Williams? Dr. Anton Titov, MD. A great baseball player. Yes, he was the last Major League baseball player to hit 400. That meant when he went to the plate, two times out of five he had a hit. Doctors are not as good as Ted Williams. So we don’t always “bat a 1000”. It means we don’t always perform perfectly. If you say, “My doctor made a mistake”. Dr. Marshall Wolf, MD. We all make mistakes! I like to think of Ted Williams. I have a much better batting average than Ted Williams, but it is not perfect. Dr. Marshall Wolf, MD. The real trick is this. You need a doctor who doesn’t think of medicine as a competitive sport. Your doctor should be comfortable saying “I don’t know”. Did you ever hear of Moses Maimonides? He’s a very famous physician, 9-th century. He said: “Teach thy tongue to say ‘I do not know’, and thou shalt progress”. It is still good advice today. Doctors have to be comfortable saying this. “I have never taken care of this kind of a problem”. Then physicians should do one of two things. They go to medical literature. Now with the computers that is pretty easy. Or they should go to a colleague and say this. “I have got this problem, I don’t know much about it. What should I do?” That is the the way patients get good care. Dr. Marshall Wolf, MD. The problem I have with patients searching for best treatment is this. Patients often are less capable of identifying the specialist they should talk to than their physician. In any patient’s medical center, a physician might see a patient with a rare heart problem. This is not a speciality fo that physician. Then talk to the cardiologists in your center about where that patient should be sent. Or who he should be seen by. A patient going to the computer may not end up in that same place. Dr. Marshall Wolf, MD. The physician should help the patient. Dr. Marshall Wolf, MD. The patient may say. “Could I have a medical second opinion?” Dr. Marshall Wolf, MD. The physician should be comfortable saying: “Sure, I’ll find you somebody”. I had patients who occasionally would say that to me. I would be glad to help them find somebody else to talk to. But it is very hard for patients without very specialized both knowledge and experience to find the right expert for their condition. That is the doctors’ job! That is the doctor’s job! I saw once a patient and the patient said. “I’m worried about what’s going on, and I know this isn’t your area of expertise. Is there somebody I could see?” I would help the patient do that. I often did. Actually more often that I would say, you ought to see somebody else, than the patient would say it. That is my job! Eminent physician and medical educator, Dr. Marshall Wolf. He speaks about mistakes in medicine and helping patients to get second opinions.
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