Patient Safety Comes First in Clinical Decisions on Second Opinion Consultations

Depending on what you can learn about the physician from the usual sources, you may wish to contact him directly; the patient could be included in this decision. You might consider simply asking the patient if she would like for you to speak with the otolaryngologist to discuss his report and recommendations and your own professional opinion. The patient may wish to just move on with you as her otolaryngologist and not “make a fuss.” On the other hand, she should be made aware, in a tactful explanation, that you do have concerns about the difference between that otolaryngologist’s clinical information and what you have learned from her evaluation today.

You do have an obligation to the profession and specialty to determine, if possible, whether there is a pattern of inappropriate diagnoses and surgical recommendations that should be addressed by the proper authorities. Obviously, the best way to confirm your suspicions would be to speak with the otolaryngologist directly about findings and recommendations. While unlikely, the patient’s name might have inadvertently been placed on the wrong clinical evaluation. We can be hopeful that is the case, so you should try to confirm the facts of the case with a direct phone call or face-to-face visit. The latter, while quite unusual in our professional interactions, would also give you the opportunity to derive a personal impression of the physician. You should also consider the possibility that the otolaryngologist is relatively inexperienced, and you might be doing him a service by helping him understand the importance of adhering to evidence-based clinical guidelines and community expectations, though you would hope that this was properly taught in his residency.

Finally, if your discussion with him indicates a general defensiveness and unprofessional reaction, then your next decision is whether or how to bring your concerns to the appropriate oversight entities. If he practices in your hospital system, then the credentials committee or specialty department leadership could be notified. Perhaps an audit of his operative procedures and their documentation could be performed. Some county medical societies have a professionalism peer review committee that could look into his practice, including working with his hospital system.

Lastly, a concern could be filed with the state medical board, either by the patient—if she is willing to do so—or by you, as a concerned and responsible physician in the community. Be prepared, however, to be identified as the individual who reported the physician, because this will come out in future proceedings. As part of the body of the medical profession, we must be willing to step forward when necessary to protect patients from unscrupulous medical practitioners, if indeed this proves to be the case in this scenario; however, you must be sure of the facts in a case so that when you step forward to accuse the other physician of wrongdoing, you can be confident in your integrity and professional responsibility. One of the three tenets of a profession is the self-policing of its practitioners. If we fail to act on our concerns about patient safety by taking the easy route and ignoring the risk to other patients, then we stand to lose a bit of our professional integrity.