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Author Topic: Second Opinions  (Read 5581 times)

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Änσnymσus

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Re: Second Opinions
« Reply #15 on: December 13, 2023, 07:48:25 AM »
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  • With this post and the optometrist's/ophthalmologist's posts, I feel much batter about things. I will still go to the other doctor and see what she says.
    This post is for the anonymous eye doctor posting in this thread (thank you so much):

    You say mentioning the acute angle issue is a judgment call by the doctor. 

    How do you think I should address my concern with the second doctor next week? 

    Should I just let her do the exam without saying anything at first and see what she says? 

    If she doesn't mention acute angles after the exam, should I then tell her that another doctor did and see what she says in response to that? 

    Or should I tell her at the beginning of the appointment about the first doctor's findings?

    Anything else?

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    Re: Second Opinions
    « Reply #16 on: December 13, 2023, 09:02:25 AM »
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  • Ophthalmology is not my specialty, but those posts were mine.

    I would be frank: "I was worried because one doctor mentioned the possibility of 'acute narrow angle glaucoma,' so wondered if there is any reason for serious concern." With that presentation, the doctor is cued that your worries need to be addressed as well as any existent risk factors, if any.


    Änσnymσus

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    Re: Second Opinions
    « Reply #17 on: December 13, 2023, 09:21:59 AM »
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  • Why not just leave it to the end of the consultation, and if it is not mentioned say "by the way, another doctor told me..." and see what the response is.

    I always think it's a good idea, when going for a second opinion, to do what this poster says:  Don't say anything at all about a previous doctor's findings.  Not sure I would even mention it at the end, but if I did, only at the very end, after Dr. #2 has given his full findings.




    Änσnymσus

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    Re: Second Opinions
    « Reply #18 on: December 14, 2023, 02:21:19 PM »
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  • Ophthalmology is not my specialty, but those posts were mine.

    I would be frank: "I was worried because one doctor mentioned the possibility of 'acute narrow angle glaucoma,' so wondered if there is any reason for serious concern." With that presentation, the doctor is cued that your worries need to be addressed as well as any existent risk factors, if any.
    Hmm.  Not sure how you know so much about eye conditions if it's not your specialty.

    Anyway, it seems I'm getting two kinds of advice.  You're saying to tell the second doctor what the first doctor said before the examination, and others are saying to wait until after the examination.


    Offline Giovanni Berto

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    Re: Second Opinions
    « Reply #19 on: December 14, 2023, 02:44:19 PM »
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  • Hmm.  Not sure how you know so much about eye conditions if it's not your specialty.

    Anyway, it seems I'm getting two kinds of advice.  You're saying to tell the second doctor what the first doctor said before the examination, and others are saying to wait until after the examination.

    Good doctors know about medicine in general.

    It is really pathetic to go to an eye doctor, for instance, who cannot give you a medicine for the common cold. 

    I would wait until the end and see if the doctor mentions the same problem as the previous one. If he doesn't, I would mention it.


    Offline Nadir

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    Re: Second Opinions
    « Reply #20 on: December 14, 2023, 02:53:31 PM »
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  • Hmm.  Not sure how you know so much about eye conditions if it's not your specialty.

    Anyway, it seems I'm getting two kinds of advice.  You're saying to tell the second doctor what the first doctor said before the examination, and others are saying to wait until after the examination.
    See how you feel on the day and LIVE IN THE PRESENT. It is all you have.

    Are you so naïve as to expect unanimity on your dilemma?
    Help of Christians, guard our land from assault or inward stain,
    Let it be what God has planned, His new Eden where You reign.

    +RIP 2024

    Änσnymσus

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    Re: Second Opinions
    « Reply #21 on: December 14, 2023, 03:14:30 PM »
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  • A risk factor is only a risk factor, not a disease. Ask your doctor how high the risk is - not very high from what the poster above suggests. Be aware of the symptoms in case something does develop - who wants to lose their eyesight - but don't become obsessed. If it is nothing to do with the reason you presented to the doctor in the first place then there is no need to be overly concerned. Being alive is a risk factor for dying - apparently in 100% of cases. Your risk of glaucoma would be lower than your risk of dying :-)
    This! 

    I know I have this variant only because when I was an inquisitive teenager, I told the eye doctor on a routine checkup that I noticed my left and right eyes reacted ever so slightly differently in the dark. He sent me to a specialist who diagnosed it and said not to worry about it. In the many years since, no other eye doctor has ever mentioned it. 

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    Re: Second Opinions
    « Reply #22 on: December 14, 2023, 05:29:28 PM »
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  • Good doctors know about medicine in general.

    It is really pathetic to go to an eye doctor, for instance, who cannot give you a medicine for the common cold.
    Are you kidding me? Medicine for the common cold??? That does not need medicine! We are a soft, over-medicalised society that has lost sight of what is the purpose of our existence.


    Offline Giovanni Berto

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    Re: Second Opinions
    « Reply #23 on: December 14, 2023, 06:04:34 PM »
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  • Are you kidding me? Medicine for the common cold??? That does not need medicine! We are a soft, over-medicalised society that has lost sight of what is the purpose of our existence.

    Common cold was just an example of a very common disease that expert doctors refuse to treat because it is not their area of expertise.

    Offline Nadir

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    Re: Second Opinions
    « Reply #24 on: December 14, 2023, 08:35:06 PM »
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  • Common cold was just an example of a very common disease that expert doctors refuse to treat because it is not their area of expertise.
    In my neck of the woods it is a long wait (maybe a month or so) to see a GP, and maybe a year or more to see a specialist.
    So a specialist is unlikely to waste time on the common cold or any other triviality for that matter. He’s flat out already with his specialty. 

    It is true they we have become a soft over-medicalised society. 
    Help of Christians, guard our land from assault or inward stain,
    Let it be what God has planned, His new Eden where You reign.

    +RIP 2024

    Änσnymσus

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    Re: Second Opinions
    « Reply #25 on: December 14, 2023, 10:44:21 PM »
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  • Hmm.  Not sure how you know so much about eye conditions if it's not your specialty.

    Anyway, it seems I'm getting two kinds of advice.  You're saying to tell the second doctor what the first doctor said before the examination, and others are saying to wait until after the examination.
    Some of us studied hard in all our classes and clinical rotations, keep up to date, weigh "research" skeptically in light of what we see in practice, don't fall for fads, and there are many specialties that expose us to a wide spectrum and considerable depth of problems in many areas. It is possible that I am one of those doctors. Maybe not. I have given you good advice.

    You want your doctor to be honest. You should reciprocate that expectation by being honest yourself.  You are now seeing a doctor for the third time because you are worried. As best I can tell from your postings, your worry (not an active medical problem) is your concern, so put it up front. Being coy serves no purpose. Being abrasive serves no purpose. Re-read the Golden Rule.


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    Re: Second Opinions
    « Reply #26 on: December 14, 2023, 11:06:53 PM »
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  • Are you kidding me? Medicine for the common cold??? That does not need medicine! We are a soft, over-medicalised society that has lost sight of what is the purpose of our existence.
    "Common cold" is a waste basket non-diagnosis that covers a wide spectrum of mild-to-potentially-deadly disease.  Certainly a viral rhinitis does not need prescriptive antibiotics. On the other hand, acute bacterial sinusitis or otitis, often called "common cold," can lead to more serious problems, such as bacterial meningitis.

    An anecdote—In my first month working the Emergency Room I saw a 26-year-old man with exactly such an acute bacterial sinusitis/otitis. It was so severe that I called the Otorhinolaryngologist ("Ear-Nose-Throat") specialist on call asking that he see the patient immediately. The specialist was abusive: "What medical school did you go to? Didn't you learn how to treat a common cold?" He raged on viciously, but I persisted. The specialist relented and saw the patient at midnight in his office. After he evaluated the patient he called me back and apologized for being abusive, agreeing that this was an unusually severe case.

    Three nights later the 26-year-old returned to our E.R. by ambulance—DEAD! I wasn't on duty that night, but my best friend from internship was on that night. He saw my medical notes from the earlier visit and discovered that the 26-year-old never filled the prescription to continue the antibiotic that the specialist had given him at the initial care. The young man died because his "common cold" progressed to a fatal meningitis.

    So, you can pontificate all you want about over-medicalization (it is true), but it may shock you to learn that there actually are cases where we doctors really do save lives. It's unclear to me if over-the-top skeptics dispensing vague snarky platitudes ever save anyone's life.

    And the last time I checked my catechism, we are tenants in our Temples of the Holy Ghost and we have a duty to be diligent in self-care. That is indeed an essential part of our "purpose of our existence."  It is a chosen "purpose of my existence" to help people as best I can. On my way to work I pray a Rosary with the special intention of doing good and begging the Holy Ghost to guide my mind and my hands.


    Änσnymσus

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    Re: Second Opinions
    « Reply #27 on: December 14, 2023, 11:44:29 PM »
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  • "Common cold" is a waste basket non-diagnosis that covers a wide spectrum of mild-to-potentially-deadly disease.  Certainly a viral rhinitis does not need prescriptive antibiotics. On the other hand, acute bacterial sinusitis or otitis, often called "common cold," can lead to more serious problems, such as bacterial meningitis.

    An anecdote—In my first month working the Emergency Room I saw a 26-year-old man with exactly such an acute bacterial sinusitis/otitis. It was so severe that I called the Otorhinolaryngologist ("Ear-Nose-Throat") specialist on call asking that he see the patient immediately. The specialist was abusive: "What medical school did you go to? Didn't you learn how to treat a common cold?" He raged on viciously, but I persisted. The specialist relented and saw the patient at midnight in his office. After he evaluated the patient he called me back and apologized for being abusive, agreeing that this was an unusually severe case.

    Three nights later the 26-year-old returned to our E.R. by ambulance—DEAD! I wasn't on duty that night, but my best friend from internship was on that night. He saw my medical notes from the earlier visit and discovered that the 26-year-old never filled the prescription to continue the antibiotic that the specialist had given him at the initial care. The young man died because his "common cold" progressed to a fatal meningitis.

    So, you can pontificate all you want about over-medicalization (it is true), but it may shock you to learn that there actually are cases where we doctors really do save lives. It's unclear to me if over-the-top skeptics dispensing vague snarky platitudes ever save anyone's life.

    And the last time I checked my catechism, we are tenants in our Temples of the Holy Ghost and we have a duty to be diligent in self-care. That is indeed an essential part of our "purpose of our existence."  It is a chosen "purpose of my existence" to help people as best I can. On my way to work I pray a Rosary with the special intention of doing good and begging the Holy Ghost to guide my mind and my hands.
    Ha ha! Nice try. That presentation was not the common cold, regardless of what your haughty specialist said. Exceptions only prove the rule. No treatment is without its risks either. There is a long standing debate in the fraternity, as you would know, whether or not to even treat otitis media with antibiotics, in spite of the rare but serious complications, for this very reason. Another snarky platitude from an over the top skeptic??? Who is being snarky?

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    Re: Second Opinions
    « Reply #28 on: December 15, 2023, 12:09:42 AM »
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  • I used quotes because those were his exact words. I don't recall verbatim the entire several minutes long phone call, but I do remember those quoted words well. So both lay and professionals will use the same waste-basket "common cold" when it suits their purposes to describe a spectrum of disease.

    //snark on

    Yes, risk/benefit analysis is part and parcel of everyone's life, not just for physicians. When we get in the car to buy groceries we have decided at some point that the benefit of having dinner outweighs the risk of getting killed in a car wreck on the way to and from the grocery.

    Thanks for your pithy analysis of "serious complications."

    //snark off

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    Re: Second Opinions
    « Reply #29 on: December 15, 2023, 01:02:12 AM »
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  • Like I said, no one should be going to the doctor for a common cold, except in exceptional circuмstances such as the immunocompromised, those on chemotherapy, for example, where what is usually an insignificant malady could be life threatening, and such patients should certainly not expect their eye specialist to deal with it! Similarly, those who develop more worrying symptoms like your ED case. But as Giovanni said, he was only using the cold to make a point. No snarking or platitudes intended.