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Question: Last week, you wrote about a patient wanting multiple second opinions. But I can’t get even a single second opinion.
I have been experiencing pelvic and abdominal pain radiating to my low back, bloating, bowel irregularities, sudden bleeding, nausea and weight loss. My GP referred me to a gynecologist who said I am fine. The gynecologist was very dismissive when I asked if it could be cancer. I got a copy of my ultrasound report, which recommends a follow-up ultrasound in a few weeks and says, “endometrial sampling may be indicated to exclude malignancy.” But no follow-up testing was ordered.
I asked my GP to send me to another specialist for a second opinion. But he said the gynecologist I saw is “very well regarded” and he “didn’t feel it necessary to involve anyone else.” My GP said he feels my condition is “hormonal” related and wants to see how things play themselves out over the next four to eight weeks.
It’s very distressing. I know I am not well and my symptoms are getting worse. But I can’t get someone to listen or do anything further. How do I get another opinion?
Answer: Your symptoms sound debilitating. I must admit I’m surprised your doctor turned down your request for a second opinion without giving you a more detailed medical explanation. At the very least, I would have expected him to do more to address your current symptoms aside from continued observation. The situation you describe makes me wonder if there has been some kind of breakdown in communications between you and your doctor.
For the benefit of those who did not read last week’s blog, let’s first recap the rules governing second opinions.
In Ontario, the province’s Ministry of Health and Long-Term Care doesn’t place a limit on the number of second opinions patients can seek for a medical condition. But patients must first get a referral from their family physician or a specialist they have seen in the past year.
This essentially means physicians act as the gatekeepers to other doctors. The Code of Conduct of the Canadian Medical Association instructs doctors to “respect your patient’s reasonable request for a second opinion from a physician of the patient’s choice.”
In order to get an answer to your question, I went back to the people who I interviewed last week: David Jensen, a spokesperson for the Ontario Ministry of Health; and Sally Bean, a medical ethicist and policy advisor at Sunnybrook Health Sciences Centre.
Mr. Jensen suggests you should book another appointment with your physician and discuss your concerns. Ms. Bean offers the same advice as a starting-off point.
This may not be an easy conversation and you may want to reflect upon your relationship with him before your appointment. Have you noticed any strains in the past? Has he previously rejected your requests? Does he explain the rationale for his decisions?
Begin the conversation by saying that you feel your request is reasonable and ask him why he thinks a second opinion isn’t necessary. Ask him to also explain what was found in your ultrasound test. And ask what can be done to alleviate your current symptoms.
“Have a bit of a dialogue about it,” says Ms. Bean.
Your doctor may have good reasons for his actions based on his knowledge of your medical history.
But if you feel no further ahead at the end of the appointment, then you face some difficult decisions. It may mean you need to look for a new doctor. Sometimes certain doctors and patients are not a good fit together. And it sounds like this experience is undermining your trust in his judgment.
“Finding a new family physician isn’t easy and takes a lot of time,” says Ms. Bean.
So how do you get a second opinion sooner rather than later?
As a last resort, Ms. Bean says you could consider going to a walk-in/after hours medical clinic or an urgent care centre (UCC) where you can see a physician without a referral. This isn’t ideal because the doctor won’t have access to your medical records or the benefit of knowing you for a period of time. But you can at least explain your symptoms to a medical professional who can serve as a sounding board. Be sure to bring along your ultrasound results for the doctor to review.
(By the way, a UCC, which can provide assessments and treatments for non-life-threatening injuries and illnesses, is not the same thing as a hospital emergency department. UCC locations in Ontario can be found on this provincial website. Walk-in clinics also can be found online.)
What you do next may depend on what happens at the walk-in clinic or urgent care centre. It may be worthwhile going back to your GP to discuss the physician’s comments.
If you conclude that a new doctor is still essential, you may want to tap into a provincial government program, Health Care Connect, which helps Ontarians who are without a health-care provider to find a family doctor or nurse practitioner.
And, of course, ask family and friends if they know of a doctor accepting new patients.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor