It's OK to Get a Second Medical Opinion

It so happens that the question of a second opinion is considered almost shameful and is often hushed up.

When you are going to spend a lot of money on aesthetics, when you are awaiting surgery, or simply when a lot depends on the doctor’s qualifications, it is not only possible, but also necessary to go for a second opinion.

At best, the second specialist will confirm the plan of the first. At worst, their versions will differ, and you will have to either figure out who you trust more, or look for a third opinion.

We immediately upload all research data, photo protocols of examinations, and records in the card to the patient’s application so that he does not have to request anything. We know that our patients often seek a second opinion, or give them advice on treatment at another clinic. Very often people from abroad come to us for remote consultations to discuss the treatment plans offered to them there.

So, the most important thing:

• This is normal practice and it is ethical.
• Good specialists understand that this generally improves the patient's prognosis.
• This is similar in usefulness to cross-review.
• Inside our clinics, cross-review is mandatory, that is, even in the usual process there is a second doctor. The same is done in the scheme where the head of the department supervises doctors in regular clinics.

The right to this is enshrined in our country by law: this is the 48th article of Federal Law No. 323. In foreign practice in many countries this right is also

supported by law

. If you don’t do this, it might be worth starting such a practice. There is one very fine line here. The relationship “an ordinary person – a narrow professional” is inevitably built on the delegation of trust. A person either trusts to treat himself, or it is better for him to find another doctor with whom he is more comfortable.

It is better to get a second opinion before starting treatment. However, if someone made a mistake with the diagnosis or chose the wrong tactics and they have already begun to treat according to it, then the unsuccessful work can be remade. Perhaps it will be longer. Or more expensive. But in most cases everything is fixable. True, this will depend on how much damage the incorrect diagnosis caused to your health. If there were no complications, then there will be no unpleasant consequences. And if there were and the condition worsened, then the doctor could be put on trial.

Why does a patient need a second opinion?

• Insure yourself against possible mistakes and be sure that everything goes according to plan.
• Make sure for your own peace of mind that no one is trying to deceive him and profit from his illness.
• Get additional diagnostics.

In many clinics, resources are limited: microscopes, tomographs and some specialized specialists are not available everywhere, and medical errors in most cases are associated precisely with insufficient diagnosis. And the doctor may not know certain techniques, and therefore he has to make a diagnosis and choose treatment tactics under limited conditions. That is, a second opinion will help make sure that the first doctor in his clinic can handle everything. Well, or he won’t cope.

Before dental treatment, in many cases it is worth looking through the same microscope. Everyone works with it, even surgeons and orthodontists, and sometimes they see very interesting moments through binoculars that no one would have ever discovered without magnification. We can only cure what we see.

According to my observations, patients are divided into two categories. Some seek treatments that involve the least amount of intervention or confirmation that as much as the doctor says needs to be done. And the latter, on the contrary, believe that their case is more complicated than the doctor thinks, and they will have to intervene more strongly. Sometimes a person does not like the treatment he receives for some internal reason. And that's okay too.

More gentle and modern approaches are often sought. If somewhere a patient is offered a harsh and traumatic removal procedure, then we have the opportunity to choose more gentle methods. For example, we detect caries in children at an early stage and use less invasive techniques. We protect children, as well as their parents, from psychological trauma, and offer treatment with nitrous oxide or during sleep.

Or here are some more examples. For a metal-free crown, minimal grinding of hard tooth tissues is required (0.5-0.7 mm), and for metal-ceramics – already about 2 mm. We always try to keep the tooth vital in order to preserve all its temperature and mechanical sensory. I can cite a lot of situations where the difference is obvious.

Another important reason to go for a second opinion is the general somatic component. For example, if a person is being treated by an oncologist or hematologist, and has recently suffered a serious injury or injury, his medical history is very important to us in order to be sure that we will not cause harm. We need to be sure, for example, that we can put a person in a chair after a lung injury (and how long we can put him in a chair). Or that his wounds will heal after installation of implants or tooth extraction, if after oncology he takes specific medications that interfere with the recovery process. In these cases, supervision of the attending physician is necessary.

But if the situation is urgent, then you first need to relieve the pain, and only then collect opinions and decide what to do next.

Why do doctors need a second opinion?

For us, a second opinion is a way to obtain detailed information about a disease, clarify or confirm a diagnosis. Sometimes – to refute. But making mistakes is normal, no one is immune from this.

Another thing worth seeking a second opinion for is the search for alternative treatments, of which there are sometimes more than one for the same diagnosis. The same bite, for example, can be corrected with aligners and braces, but some things can sometimes be corrected with the help of crowns and veneers. And in principle, orthodontics is a very creative profession, because teeth can be moved in very different ways.

They also periodically leave us for a second opinion. I have a normal attitude towards this, because I am completely confident in my actions and the diagnostics that can be done at White Rainbow. It happens that a person receives a treatment plan from me, and then goes off to look for where it can be done cheaper. And even if he doesn’t return (although this still happens more often), he remains grateful that we suggested how to do it right.

There are also such collisions: someone is incredibly lucky to have a tooth with five canals, and we saw this on a CT scan. The lucky guy shrugs his shoulders and goes to the dentist near his home, where he is happily told that he can’t possibly have more than three canals, and this is some kind of money scam. A person comes to us to be indignant, we give him all the pictures, and he goes to another place for treatment… And then he returns with complications and with the words: “It turns out that you were right after all.” And we continue to treat those channels in the existence of which he initially did not believe.

A little about medical jealousy

When a person comes to us, we always check with him whether the attending physician knows where he went. Not because we are worried that he will be scolded there, but we just want to look at the extract from the card. And we don’t want to repeat studies that have already been done. Or figure out what new we want to see that is not in previous photographs. We need information not in words, but documented: it’s more reliable. Getting it through your attending physician is easier than making official requests to the clinic.

And although there are indeed doctors who become jealous of their patients, we do not have the task of luring them to us. Rising up at the expense of other people's mistakes is the same. We won’t cover for them, but setting a patient against his doctor is also a bad idea. So we will express our opinion clearly, but gently. Not “Who did such a cruel thing to you?!”, but “We see treatment a little differently.” We can prescribe and talk through everything we saw, and then the choice is up to the patient himself.

And more about mistakes. I always tell my doctors and students that if the doctor made a mistake, for example, broke an instrument in the canal or did not remove a piece of the root, then the patient has the right to know about it. First of all, it's just honest. Secondly, it gives you a chance to correct the mistake immediately. No one deliberately wants to cause pain and suffering to the patient: I have never met dental maniacs. Well, thirdly, anyway, everything secret will very quickly become apparent, and instead of awkwardness and embarrassment, there will be a scandal. In the early 2000s, when photographs were still film and did not go into any databases, errors could still be bashfully hidden. Now we are in a time of hyperdiagnosis, when everything is open. After all, if something goes wrong, the same patient will go to another clinic and then return to you for compensation. He will be incredibly angry! And to explain something to an evil person is not easy, to put it mildly. Therefore, if something did not go according to plan during treatment, you need to talk about it in the moment.

If the doctor categorically states: “Why do you need to go somewhere, I’m treating you normally,” then this is alarming. If the patient has already started treatment with him, then the thought immediately arises that something has gone wrong, and he really wants to hide it. Well, or it’s such jealousy and a desire to hold on with all one’s might. And if the treatment has not yet begun, then this story looks even more suspicious, because the doctor is not yet connected with any financial obligations to the patient.

Don't forget your documents

For a second opinion, all documents and extracts that the patient already has are important. And if the situation is complicated by serious somatic diseases such as diabetes or oncology, then extracts are needed not only from the dentist, but also from the attending physician.

If there are doubts about the correctness of the treatment plan, then it is also worth requesting the plan with a list of all manipulations, so that you can then compare it with the proposed alternative. For example, if a person needs total rehabilitation, which he cannot afford financially at the moment, but will return to it later, then he can ask to outline different treatment options.

When patients leave us for a second opinion, we each time clarify what documents will be needed to consult at another clinic, and without question we give everything they ask for. They already have most of the information in the app. We don’t feel sorry, it’s important that in the end everything goes well for the person.

When a second opinion is especially important. A few illustrative examples

It’s definitely worth going for a second opinion if there are any rare pathologies: abnormal arrangement of teeth, non-standard anatomy, rare concomitant diseases, and so on. In the latter case, you need to involve specialized doctors in the issue.

I have a very strong memory of a semi-detective story about how an acquaintance of one of our doctors’ acquaintances came to us from Volgograd because he did not have enough diagnostics at home. He had a toothache. They never understood what exactly happened: the pain was sluggish and not very pronounced. And then his doctor made a mistake and missed the tumor due to underdiagnosis. He took a picture, saw a huge inflammatory focus, decided that the canals needed to be treated, and got to work. The nerve turned out to be surprisingly alive, which in principle could not have happened with such a large lesion, but this did not bother the doctor. He worked according to the classics: he cleaned out the nerve, filled the canal and began to wait for the pain to go away. The pain did not go away, and the man came to us. We requested information from his clinic, saw that the entire “inflammation” did not fit on the picture, and did a CT scan. According to our rules, we have to do either a CT scan or an OPTG, if everything doesn’t fit on a small picture, in order to understand what it is and where it ends. In addition, carry out differential diagnosis. In general, on the CT scan we saw a huge tumor that could easily break a person’s jaw if it had grown a little more. Fortunately, it is benign. And the outbreak was not associated with the tooth that the doctor treated. We took the patient into work, involved surgeons, did decompression and somehow dealt with this matter. We made it.

Sometimes people come for a second opinion for whom our price tag is completely unaffordable. But they somehow need to be treated, and preferably qualitatively. For example, recently the mother of one of our patients came, brought a treatment plan from another clinic and asked to check how adequate it was. It was important for her that I look at her under a microscope and do some additional research. She also honestly warned her doctor that she would come to us for a second opinion, and he reacted to this very adequately and humanely. We described the plan to her as we see it, gave her all the pictures and studies, and she went to her clinic for treatment. In general, everything was as transparent and adequate as possible on both sides. It's nice when it's like that!

One day a woman came who was simultaneously being treated in another clinic. There she was given an implant, which successfully disintegrated. And although the tooth was still under warranty, she was afraid to go there and came to our surgeon with an orthopedist. The guys drew up a treatment plan for her, but they seemed too young and inexperienced to her, although both were excellent specialists. The woman asked us if she could have an older doctor, and went for a second opinion to our top orthopedic surgeon: he was just older. He examined her carefully again and confirmed the tactics. And then there was a choice: either continue to be treated by him, or return to the first two guys. She became convinced that young doctors also had experience, and eventually returned to them.

And one day a man came to us who had supernumerary wisdom teeth. And they were still lying so atypically that it was immediately clear that the intervention would be serious, traumatic and under anesthesia. We could have done it, but the man went to find out if it would be cheaper elsewhere. He never returned to us, so he most likely found him.

A little bit of hype

At the beginning of this year, we had an interesting story when a dental blogger from the Moscow region, the owner of a small clinic, brought his wife to us for an appointment using anesthesia. We understood: he just really wanted to know what was inside us, and to stand up a little against our background.

It became clear that he was a blogger when, after treatment, tricky questions began with attacks from the series: “Why did you do it this way when you should have done it differently?” The questions were as if they had been specially invented to post screenshots of the correspondence somewhere. Objectively, there were no reasons to make any complaints, we followed all the protocols, and it all looked a little bad.

I Googled the last name and actually found a cozy account with the same screenshots of correspondence, photographs from our clinic and comments in the style: “These advertised guys are no better than ours. Come to the appointment – save money! ”

We were flattered, I think. I wonder what they will do when the wife runs out of bad teeth, but there are no good clinics that you want to look at from the inside.

How it works in our clinic

We have a special “Second Opinion” service. And there is also an online consultation – especially for those who cannot get an appointment in person because the border is closed or the person lives somewhere far away in our country. We can look at the CT results, analyze it and discuss treatment tactics. Sometimes people ask us to consult their doctor. And sometimes they are just trying to understand how serious everything is, whether they can be cured at home or will they have to go somewhere to get the help they need.

And that's okay. The doctor from whom the patient leaves for a second opinion always wins. If his ideas are confirmed, it will be further proof of his coolness. If not, he will gain invaluable experience and security from a legal point of view.

A few final words

We will never keep anyone with us at the cost of their health. Sometimes there are such stories that here – only in the hospital. For example, when a person has a large abscess that is about to develop into phlegmon. Of course, we have an operating room and great surgeons, but we are still an outpatient clinic and cannot provide emergency care. Of course, we won’t send you out into the street with the words “My friend, you’re going in the other direction.” We can call an ambulance ourselves. Or refer you to a specific maxillofacial surgeon.

And if the case is extensive, but it can be treated on an outpatient basis, then we offer a choice: either go to the hospital or have surgery with us. Sometimes it happens that the patient is simply not ready for extensive intervention, for example, because it is expensive for him. We will not abandon such a person either: we can relieve his acute pain, close the tooth with a temporary filling, and then he can, with a cool head, in which not a single tooth hurts, decide where he will go next for treatment. Simply because when it is very painful, a person is ready to give any money just to feel better.

Our important rule is to be a doctor with a clear head, and not one who wants to make money right away. And not for those who want to get rid of a difficult patient. Then alternatives appear and peace comes. According to my observations, people often come for a second opinion because the first doctor seemed too fussy and unsure of his actions. Even if he said everything correctly.

And, what is especially important, if a person receives two opinions, then he automatically becomes an equal participant in the process. He will not be able to stay away: he is automatically involved in the process and becomes responsible for making decisions. And this, you see, is reasonable for all participants in the process.