Doctor should be able to say, ‘I don’t know’ …On importance of second opinion
Eminent physician and medical educator, Dr. Marshall Wolf, – on mistakes in medicine and helping patients to get second opinions:
Many people think they’re getting the best diagnosis and treatment: they have good health insurance or they live in a country where the state covers costs of their health care, and they live next to a large, perhaps academic hospital. But in reality they might not get the best care for them. Their diagnosis could be incomplete or imprecise, even though it’s generally correct, and their treatment methods or strategy might be available in a much better way somewhere else. So this is what happened to my mother, when she had a lung tumor diagnosed, which turned out to be a rare lung tumor. So the initial diagnosis: “Elderly lady, nothing to do” actually proved *not* to be the best course of action, and it took a very detailed medical literature search, and global [medical] network consultation to find another physician – similarly experienced, working next door to the first doctor, who looked at this picture and said, “Look, we’ll do a couple of tests, we can proceed to surgery immediately, and then she will not need chemotherapy or radiotherapy”. And that was several years ago and it worked! – Is she doing well? – Yes, my mother is doing well – It worked well, and it really prompted me to start this interview project, because so many people are not getting the precise diagnosis and the best course of action, because they don’t probe further – and cannot probe further [to find best diagnosis and treatment for them]. How can patients make sure that they’re getting precise diagnosis and best treatment? And a corollary to that is – what do you think of patient-initiated efforts to seek a second opinion and alternative expert opinion in more difficult situations? – Okay, well, two things: You know Ted Williams? – 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. And so we don’t always “bat a 1000” [= we don’t always perform perfectly] So if you say, “My doctor made a mistake” – We all make mistakes! I like to think of Ted Williams… I have a much better batting average than Ted Williams, but it’s not perfect. I think the real trick is – you need a doctor who doesn’t think of medicine as a competitive sport, and is willing to be comfortable saying “I don’t know”. Did you ever hear of Moses Maimonides? He’s a very famous physician, 9-th century, and he said: “Teach thy tongue to say I do not know, and thou shalt progress”. It’s still good advice today. So doctors have to be comfortable saying “I’ve never taken care of this kind of a problem” – and do one of two things: go to literature, and now with the computers that’s pretty easy, or go to a colleague and say, “I’ve got this problem, I don’t know much about it, what should I do?” I think that’s the the way people get good care. The problem I have with patients searching – they often are less capable of identifying the person they should talk to than their physician. So if in your medical center, if you saw a person with a rare heart problem, which is not your field, you would know, which of the cardiologists in your center you want to talk to 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. So I think the physician should help the patient. And the physician should be comfortable, if the patient says, “Could I have a second opinion?” – saying “Sure, I’ll find you somebody”. I had patients who occasionally would say that to me, and I would be glad to help them find somebody else to talk to. But also people say that it’s very hard for patients without very specialized both knowledge and experience to find the right expert for their condition – That’s the doctors’ job! That’s the doctor’s job! – and the doctor… If I saw a patient and the patient said: “I’m really 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, “I think you ought to see somebody else” than the patient would say it…That’s my job!