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Do you trust your doctor? Most people will answer yes. In fact, most doctors of any specialty are highly trained, caring and competent people and are deserving of their patients’ trust.

Does that mean that you take any advice or recommendations from your doctor as being the final answer?

Although there is a fair amount of agreement among healthcare professionals about diagnoses and recommended treatments, there is a fair amount of disagreement as well.

Many patients tend to depend upon one doctor’s opinion almost exclusively. Considering that there are often variations in opinions about whether a diagnosis is accurate or whether there may be associated concurrent diagnoses as well, and that there are multiple ways to approach treatment for most health problems, it may be time to be thinking about the value of second or third opinions.

Doctors of all specialties vary in their level of skill. To illustrate this point, I recall a conversation I once had with a friend who often served as an expert witness in malpractice trials and other legal matters.  During one particularly vigorous cross examination a lawyer posed the question, “Well doctor, doesn’t my client deserve the best qualified, highest trained doctor available?”

The expert witness answered, “No.”

The lawyer was taken aback and demanded to know why not.

“Your client is entitled to the same level of care that you, me and every member of this jury is entitled to. We are only entitled to be cared for by the least qualified doctor that has managed to pass the state board evaluations and be granted a license to practice.”

The lawyer was stunned almost to the point of silence, then asked the expert witness to explain his seemingly absurd answer.

“The state has set forth written requirements for the training that each doctor must attain and then pass board examinations to be granted a license. The fact is that although the requirements are very thorough, there is always someone at the bottom of every class that manages to just squeak by. That person is granted the same license that the top doctors receive. They have all the practice rights and privileges as the most highly qualified practitioners.”

He continued, “We as patients are protected by the state by the setting forth of the requirements, but once a doctor passes the board and receives a license, they are deemed to be qualified. Therefore, we are all entitled only to be treated by the least qualified doctor that can pass the requirements.” 

That sounds somewhat dismal but it is obviously true of all professions. In reality, the training is thorough for professionals and licensing requirements are quite stringent, so the public can depend on the qualifications of their healthcare professionals. But the fact remains that there are differences in the level of training and abilities among them.

There are additional reasons to seek other opinions. Between specialties there are differences in recommendations of how to treat various problems.

As an example, a patient came into my office recently with back pain and numbness and tingling that affected the left leg all the way to the toes. He brought recent X-rays of his lower back with him. The problem had persisted for more than a decade and has recently been getting worse.

Any spine specialist would recognize by his history that he has nerve root impingement (pinched nerve) likely from a disc problem of some description. They would also realize that plain X-rays are limited in their usefulness since discs or nerves do not show on X-rays. An MRI is necessary to accurately diagnose the problem.

At the previous clinic this patient had been prescribed pain medications only. He stated that he felt better for a few hours but the relief was partial and went away as soon as the drug wore off.

I wondered why the other clinic had not ordered an MRI to clearly diagnose the problem rather than “kick the can down the road” by prescribing pain relief only. Maybe the patient had refused an MRI?  I don’t know what happened there so I can’t guess.

The point is that they may have had a good reason for doing what they did, but it was not the best way to accurately diagnose or resolve the problem.

Suppose they had ordered an MRI and discovered that the patient had a bulging disc at L5 (very likely).  What would the clinician do? They may prescribe some steroid medication or recommend physical therapy or perhaps refer the patient to a neurosurgeon. The neurosurgeon may recommend physical therapy or perhaps recommend spinal surgery.

The patient happened to have gone to a hospital in the interim and there the doctor recommended he see a chiropractor.

In my office, after a thorough physical examination and review of an MRI, he may be advised to have some advanced chiropractic care that can often resolve disc problems or perhaps receive non-surgical spinal disc decompression therapy.

In this example, the patient had already had several encounters without an accurate diagnosis and the problem had not been resolved in 10 years and was getting worse prior to coming to my office.  (But I do not know what all other providers had recommended and whether the patient had been compliant or not.)

This illustrates the variations in approaches taken by various providers and the need to sometimes be persistent to find a solution. For serious problems that may require surgery or other invasive treatments or for problems that are persisting, a second or third opinion is often a very good idea.

Dr. Mark Kestner is a chiropractor in Murfreesboro. His office is at 1435 NW Broad St. Contact him at mkestner@DrKestner.com

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