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A medical specialist offers his views on second opinions “Specialist knowledge is a must“

Issue 02/2016

Since 2015, patients in Germany have had the right to a second medical opinion for certain surgical procedures. Prof. Dr. Jürgen Harms, a specialist in orthopedics and trauma surgery, thinks this is generally not a bad idea.

Prof. Dr. Harms, what is your personal view on a second medical opinion?
Prof. Harms: I am definitely in favor of second opinions. People can make mistakes and be wrong – physicians are no different in that respect. But in medicine, in particular, this can have shocking effects. Safe decisions about therapeutic actions can only be made when the initial examiner has enough expertise. This is particularly true for diseases that are not part of the daily specialist field.

Which problems can be linked to a second opinion?
Prof. Harms: I believe that there are two general problems. First: How do I, as a patient , find a suitable physician for my second opinion? I think that only a physician who is highly qualified in the relevant specialist field and who has attended relevant further training should be authorized to give a second opinion. Such a physician should demonstrate sufficient case numbers of his/her own, in particular for surgical measures, because medicine is a science based on experience. It is also important that this physician is independent of health insurers or other institutions to ensure the second opinion is neutral. Second opinions which are under the control of health insurers or other institutions that are directly involved in the financial result of these surgical procedures must be avoided at all cost.
The second problem is the patient him-/herself: The patient’s desire for a second opinion is absolutely justified, of course. Sometimes, however, patients acquire their own knowledge via research on the Internet or other media, which is often incorrect. A sound explanation of the diagnosis and treatment by the initial physician as well as the physician giving the second opinion is therefore very important.

Prof. Dr. med. Jürgen Harms operierte über 30 Jahre als Chefarzt der Orthopädie und Wirbelsäulenchirurgie am Klinikum Karlsbad­Langensteinbach in Karlsbad und ist mittlerweile an der Privatklinik Ethianum in Heidelberg tätig.
Prof. Dr. med. Jürgen Harms operierte über 30 Jahre als Chefarzt der Orthopädie und Wirbelsäulenchirurgie am Klinikum Karlsbad­Langensteinbach in Karlsbad und ist mittlerweile an der Privatklinik Ethianum in Heidelberg tätig.

When do you consider a second medical opinion as useful?
Prof. Harms: I think it is important to give the patient the option of a second opinion for complicated procedures with a substantial risk of complications. For standardized treatments that exist in nonsurgical as well as surgical therapy, however, a second opinion is not absolutely necessary, provided that the patient has recognized the basic problem and can understand the treatment. Whether a second medical opinion is obtained or not also depends very much on the patient’s mentality and level of knowledge. For me, it is always important to find out about the patient’s expectations because those and the surgical outcome often do not match.
In general , I would like to add that it is an advantage if the physician who was asked for a second opinion is given the opportunity to personally examine the patient as well because even experienced physicians can make the wrong decisions if they are solely based on the contents of the patient’s file. Furthermore, the first and second physician should always communicate.

Pictures: Conny Kurz, fotolia.com/forestpath