Tuesday, March 5, 2013

Second opinion

We sometimes hear the word “second opinion”.
It means to listen to another person about the problem, usually a medical matter.

Medical science is extremely derived to many kinds of specialty. No doctor knows all of the human body and mind. For example, I am a psychiatrist and can introduce myself as a physician in Japan. But I cannot treat a patient with severe pneumonia as well. As well, most physicians cannot treat severe depression like I can.
So no one can treat a whole human. But doctor in charge is to be consulted by his patients. When the patient is suffering from a certain disease which the doctor in charge is not familiar to, he would consult another specialist. It is a second opinion.

It is often misunderstood about the purpose of a second opinion. The patient met another specialist should visit the doctor in charge again to discuss the strategy of treatment. Even if he thought that the specialist doctor was superior to the doctor in charge (it is ordinary, as a specialist is superior to a generalist in the specific matter!), he should not apart from the doctor in charge. Otherwise it would be simply changing doctors.

However, in Japan it happens frequently.

One of the reasons is health insurance in Japan. All Japanese belong to national health insurance (or insurance for employees). Patients can visit any doctor, anywhere they like, to be treated by health insurance. All physicians are obliged to treat any patients in front of them. In Japan free access to health care is certified. This is one of the unique character of the Japanese social health system.
So a patient who does not believe the doctor in charge can change his doctor with free.

Therefore, patient-and-doctor relationship is hardly established in Japan, especially in urban areas. For patients, it is advantageous to choose the best doctor for him. On the other hand, it is difficult to give continuous therapy for a long time, which makes the problem around chronic disease more complicated. In psychiatric region, some patients change doctors very frequently, they are called “doctor shopping”.

In general, a second opinion is hard to function. When you were given an advice, which you do not agree with, you perhaps want to get a second opinion. But it is not second opinion, but you merely want to find someone to agree with you.

1 comment:

  1. I agree with you. One of the biggest reason of this problem is ---If I am allowed to say it--- too much free access. In other Western country it is not. You must book doctor many, many weeks in advance... As Japan has finacial problem (crisis?), it is impossible to continue this system forever. We must give up one of those--, free access, payment, and quality. I think free access is the one which is easy to choose.