When someone gets injured, what goes through the mind of the patient? Fortunately, it doesn’t take advanced psychology to figure out the immediate questions that arise. It roughly goes in this sequence – how bad is it? Will it get better soon? How fast can I resume with my normal life? Will I need extensive medical care? Can I afford that treatment? (Unless you have health insurance or are rich enough!)
These questions are no different for a physiotherapy patient. The constant race to get the best possible treatment at an affordable cost is a typical patient’s struggle. But for a profession that deals with injury intervention and effective outcome, patients are inclined to find better solutions, largely due to low patient-physio trust and lack of statistics. This is where physiotherapy went wrong – normalizing second opinions.
Now let’s get this clear – second opinions are not wrong – neither ethically and definitely not medically. In fact, many consultants will recommend second opinions because even if the case they’ve encountered is standard, differential diagnosis will suggest an alternative treatment based on individual patients. However, not only is this costly and time-consuming, but also mentally draining. Imagine paying multiple professionals to repeat how bad your condition is and what’s needed to revert back to normal or in some unfortunate cases, control the damage!
Despite this, most patients prefer good health over money, which means they are ready to spend more than what they’re comfortable with. This leads to what’s commonly known as “doctor shopping” – a situation where patients consult several doctors unnecessarily before deciding on a prescribed treatment plan. Unless a patient suffers from an extremely rare case that needs multiple consultations (chances of which are near zero), doctor shopping is purely due to lack of trust and impulsiveness.
About 40% of all surgeries happen after second opinions. This is a statistic most physios are aware of. Second opinions have become so mainstream, that not taking one is considered risky, even in the most standard cases. This is because till date, prognosis is primarily subjective. Even if the physio is a hundred percent sure, the lack of data to assure the patient is where they lose them.
But while most factors depend on the quality of the physiotherapist, patients one of the most important factors in their treatment – adherence. While adherence is not completely under the control of physios, there are some things doctors can do. According to a remarkable Norwegian study, most patients adhered to treatments where they had a greater say and the nature of their recovery was active treatment i.e., exercise and self-management. So a key element in developing trust seems to be to allow patients to exercise more control over their treatment, and let them know of a possible timeline!
While adopting methods to avoid second opinions without reducing its effectiveness is all well and good, what we must accept is that it’s unlikely it will ever not be standard practice. But for the welfare of the healthcare community, making sure patient adherence is improved, prognosis is data-oriented and doctor-shopping is discouraged is the best way to ensure patients get the right treatment and have the best possible recovery.