Verum PG

It was around 10 years ago and I was in final year MBBS. To be perfectly honest, even after almost 4 years as a medical student, I still barely had much of an idea about how the actual practice of medicine was like. 

It is only really during internship that we truly begin to understand about the different aspects of practicing medicine that you won't find in textbooks. One of those is how to counsel a person that he/she will require surgery. 

Crash

So one of my batchmates' father got into a road traffic crash and sustained an intraarticular distal radius fracture. This means the fracture is going into the joint and usually will require surgery. This was communicated to the family by the senior resident of Orthopaedics on duty that day. 

While this was explained in calm and detailed manner on multiple occasions to multiple family members, there was a group sense of denial which was expressed in a range of insults to the doctor, referring to him as "Just a PG". This sentiment was also shared by my batchmate. 

Unsatisfied with that answer, they decided to go doctor shopping around the city looking for any orthopaedician who would agree that surgery would not be required. 

Some of them were even kind enough to meet them at their home after normal working hours but the answer was always the same. Surgery would be required. 

Ultimately they would get over their denial phase and accept that surgery would indeed be required. 

As fate would have it, they would return to the hospital they started at for surgery because it was a government hospital and the treatment would therefore be mostly free. 

He underwent successful surgery and had a very good outcome. 

Second Opinions

There are several things to learn from this story. 

Firstly, everyone has the right to a 2nd opinion, unless it's an immediate life or death scenario where death is almost guaranteed with any kind of delay from changing hospital or trying to find another doctor. In other cases like these where something is required but not necessary in the same day, then it is perfectly within people's rights to seek another opinion if they wish to do so. 

What's not appropriate though is belittling a doctor's opinion and insulting him. Just because you don't like what a doctor is telling you doesn't make it false, as was proved in this case. Maintaining a sense of respect on both sides is important and frankly, not many surgeons would have been as patient with the above family's actions as the original doctor was. 

Secondly, medical students have little idea about a lot of things but some are unwilling to accept their limitations. They are many HODs out there who are willing to admit that some things are outside their area of expertise. Unfortunately some MBBS students believe they have some obligation to their family members (who are really just looking for free advice) to give opinions on things beyond the MBBS level. My batchmate confidently told the family surgery would not be needed. Similarly students often comment on even more complex issues - should this patient be on a ventilator or not? How do you treat an amniotic fluid emboli? Can you read this MRI film? 

A bit of humility can go a long way. There is no shame in admitting you're a trainee and not qualified to answer these questions. You can tell them that you'll ask people who are more qualified and get back to them. Furthermore, the experience of a senior resident who has passed many more exams and has been practicing for several years should not be belittled. 

That being said, they are many residents who are also just as guilty (albeit to a lesser extend perhaps) in belittling their colleagues. With all this mind, you can again clearly see why the general public asking for a second opinion is neither surprising nor unacceptable. 

Thirdly, sometimes it takes people time to understand the situation. Sometimes you need multiple people to advice you to do something before you finally come around to it. Sometimes what you want to hear is not what you need to. 

The problem comes when there is a life or death situation to wait for another opinion (crash intubation, emergent cricothyrotomy, pneumothorax decompression etc). In an emergency scenario, the best person to manage will be the person seeing the patient. Not the person on the phone sitting at home. Most doctors in those scenarios do whatever they feel is in the patient's best interest. 

The nearest tertiary care hospital is likely the best option for such cases rather than roaming around the state (or even crossing states). Significant delays in care in time-sensitive emergencies can result in grave consequences. 

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