In brief:
- Patients have the right to question their physician's advice and may choose to see a different healthcare provider.
- The fact that a patient seeks a second opinion should not be interpreted as a breakdown in the doctor-patient relationship.
- Usually, the second physician's opinion will reinforce your opinion and satisfy the patient.
- If the second physician’s opinion conflicts with yours, you are under no obligation to provide treatment that you feel is not medically indicated, not supported by scientific evidence, or outside your area of competence or experience.
When you are the treating physician
Patients have the right to make decisions about their health, do their own research, and seek second opinions. However, second opinions can sometimes create confusion. If the second physician or practitioner confirms your assessment, there is no conflict. But if the patient receives a different diagnosis or treatment plan, they may come back to you and request a different therapy.
As the treating physician, you are under no obligation to provide treatment that:
- you feel is not medically indicated
- is not supported by scientific evidence
- is outside your area of competence or experience.
Any treatment or therapy you provide must be in accordance with a recognized and accepted standard of practice and should conform to the applicable medical specialty and medical regulatory authority (College) guidelines.
It may be difficult to manage situations where a patient is asking for treatment you do not believe is medically indicated or supported by scientific evidence, or is outside your scope of practice. Being empathetic, listening to the patient, and providing a thorough explanation for your decision can help resolve the situation.
When you seek a second opinion from a consultant
When you, as the treating physician, seek a second opinion from a specialist consultant, you should strongly consider the consultant's advice and incorporate it into the treatment plan if you deem it to be appropriate. If the clinical situation evolves or the advice does not seem appropriate, a follow-up discussion with the consultant may be warranted.
It is important to remember that when a second opinion is sought, either independently by the patient or through a referral, responsibility for the care of the patient remains with you, the treating physician. You are expected to make your own assessment and formulate your own treatment plan, and you should discuss the advice received and the final treatment plan with the patient. When two or more physicians (treating and consulting) are involved in a patient’s care, it would be wise to clearly outline each physician’s role in initiating treatment and providing follow up care.
When you are asked to give a second opinion
Physicians are sometimes asked to provide their professional opinion in a variety of circumstances. For example, a patient may ask the physician to comment on the care plan being proposed by another physician. Before offering a viewpoint and providing a second opinion, you'll want to ensure that you have all necessary background and clinical information (e.g., history, physical examination findings, and lab tests).
Keep an open mind and remember there is often more than one way to manage a medical condition. An ill-considered comment about care being provided by others can create dissatisfaction and lead to a patient launching a complaint or lawsuit. Consider having a discussion with the treating physician to obtain their perspective, particularly when the facts and circumstances are not known to you.
Informal requests for second opinions
An individual could ask you for a second opinion or seek your medical expertise informally outside your practice – such as at a social event or over email. In such a scenario, you could explain to the individual that, given the circumstances, there are both ethical and legal reasons why you are unable to provide medical advice. You could ask the person whether they are already under the care of a physician and suggest that they contact a physician who would have access to their medical history.
If you do choose to offer advice, you have a duty to provide advice that meets the relevant standard of care, irrespective of the venue. In situations where the individual's symptoms appear urgent, recommending that they seek care from an emergency department or urgent care clinic may be appropriate.
