WHEN DOCTORS’ OPINION DIFFERS

Many people think of medical science as a simple discipline, where everything is in black and white. They naively believe that all doctors, irrespective of their specialty or where they practice, would take a patient’s history, look at his medical record, recommend some investigations and then formulate a treatment plan which will be exactly the same, no matter who the doctor is.

Unfortunately, this is not to be, and the fact remains that medical practice is not just a science, but it is also an art, and requires expertise. When doctors disagree, the patient is often left confused and upset, because he is then not sure who to trust, and it is hard to deal with uncertainty. There are doctors who would advise comprehensive investigations to be done for a certain ailment, while others feel that this is not required if the history given by the patient and a fewer number of investigations point towards that particular illness.

This also means that if a patient who goes to a doctor to get himself treated and does not get well, goes to another doctor for a second opinion, and this new doctor starts with a thorough investigation before starting the treatment for the disease, the patient is going to feel cheated. The patient tends to complain that the earlier doctor was negligent, and that the reason he did not get well earlier was because the earlier doctor did not bother to fully investigate before starting with the treatment. He jumps to the conclusion that the earlier doctor was sloppy, careless and incompetent because he did not test him properly before doing his treatment. He might even feel that the doctor was out to make money from him, without any compassion for the patient, which is why he took a short-cut which resulted in the failure.

This reasoning is flawed.  It is not always compulsory to perform a detailed investigation for every case, as most of the times the detailed history of the patient and some routine investigations do the job, and whether or not the doctor had ordered for a complete investigation is very unlikely to have changed the outcome of the treatment. However once the seed of doubt has been planted in the patient's mind, he loses confidence in the doctor. The problem is that once a person loses confidence in one doctor, he loses confidence in all doctors. He starts treating all of them with suspicion and wonders whether they know what they are doing.

The fact of the matter is that doctors disagree because each of them has his own preferences, which is quite acceptable. The problem arises when doctors do not explain what they are doing and why they are doing it.  This is not because doctors are trying to hide information from patients. It is just because they do not think it is obligatory to tell the patient the reason for prescribing or not prescribing a particular investigation or treatment. Many doctors also believe that the patients should trust them and accept whatever advice they give them, without any counter questioning.

When there is a discrepancy between what one doctor advises and a second doctor's opinion, this does not mean that one is wrong and the other is right.  People need to be mature enough to understand that there can be more than one approach to deal with a particular ailment. They need to appreciate that no one doctor has a monopoly on knowledge. If there is a difference of opinion, this is not because one doctor is clueless, or the other is smarter or better informed, but it's simply because that there are no black or white answers in medicine. Patients need to do their own homework first, so that they can find the treatment path which they are most comfortable with.