When you are asking for a second opinion, giving a second opinion within your field, or asking for or receiving a consultation from a specialist outside your field, it is essential to remember that rarely in medicine will you be able to follow a “one size fits all” approach.

 

Your colleagues have expertise outside of your own

 

There are usually several accepted, evidence-based treatment options and different ways to administer those treatment options. In addition, it’s important to remember that there are many other factors that affect treatment recommendations, including the patient’s insurance status, support system, personal wishes, and preferences related to quality of life. 

As physicians, we often forget that the patient is at the forefront of our treatment, as we tend to let our egos impede this, especially when working with other specialists. I, like most physicians, want to work with specialists who take all these factors into account and, above all, are respectful. 

 

A personal anecdote

 

I once consulted an infectious disease doctor to help me with a patient who had a nasty infection that was resistant to most mainstream antibiotics. I put in the order for a consultation and contacted the specialist's nurse to pass on the case details. The following day, as I made my bedside rounds, I saw the specialist’s comprehensive notes and recommendations. He knew the patient was uninsured and considered this when deciding on a treatment regimen.

He outlined his thought process in detail, explained how to order the recommended antibiotics, and requested that I place the order as I was the patient’s primary physician. I went to see my patient to tell him the plan and, to my surprise, the specialist was already in the room speaking with the patient and his family. The specialist introduced himself to me kindly and respectfully as I listened to the conversation, where I learned about antibiotic resistance specific to this complicated case. 

 

Consulting for treatment options

 

When I am the one who is being asked to consult on a case, for a second opinion or to take over care for a colleague’s patient, I try to remember to show kindness and respect—even if I disagree with the other physician’s treatment plan. 

If I disagree with an aspect of the care plan or if I have an alternative idea that I believe wasn’t considered, I try to show kindness in the language I use as well. I’ll use phrases like “could consider,” or “an alternative could be,” or “in my practice, I sometimes use (blank).” And I make sure to thank the referring physician for allowing me to provide this service. 

 

Learning from a trusted network

 

 

A good specialist will write thorough notes in the chart and follow up with you on the phone about a patient, if necessary. Maybe you can learn about a new cancer drug or a new, more affordable antibiotic regimen. 

 

Medicine is a lifelong learning career path, and having a trusted network of specialists can be pivotal in your learning journey.

Building a trusted network of specialists ultimately allows you to provide better service to your patients. One of the most critical aspects of the art of medicine is treating the patient—not just the disease. This means being familiar with their insurance and financial status, support network, and living environment. You could even find a specialist who has specific experience with certain patient populations. 

Maybe you know a specialist who treats uninsured patients, or who works most closely with a specific minority patient population, or who is a LGBTQ+ patient advocate. Working with a trusted network of specialists means getting to know these physicians deeper and establishing a better understanding of how to interact with certain patient populations. 

 

You can provide better continuity of care

 

Referring to specialists with whom you have a working relationship means you can have a more direct and open line of communication for specific cases. You can ask them difficult questions about your patient's case, and you can expect an open and honest answer. 

A trusting relationship like this means you can provide better care to your patients, because you have a better understanding of their cases and can schedule patient and family meetings with both yourself and the specialist. Hence, everyone can work together as a team. There is less back and forth, fewer gaps to fill, and less uncertainty.