2nd opinion within practice

[schmee90]

Curious what others experience with 2nd opinions within the department are. Had a patient with with a colleague get a lumbar RFA years ago, I repeated it she didnt didnt get much benefit. She threw fit wanted to go back to my colleague which our department typically doesnt do but allowed. I haven't talked to him about it but he repeated the procedure at the same level with signficant benefit. I re reviewed my needle placement and feel mine are very good, Ive done thousands being a few years outside of fellowship and had in my mind a good rate of success. Also looked at my colleagues pics who actualy didnt look as good as mine to be honest, but cant argue with the results.

Im glad the patient is feeling better, but also feel like it makes me look pretty bad. We have PA-s who see routine post procedure follow up, their note was like patient had lumbar RFA with Dr. *** with no improvment and repeat inejction with Dr. *** with great improvement.

Maybe its just a shot to the Ego and I should humble myself, but I I know how to do lumbar RFAs and have lots of patients who do really well.
Just curious about other peoples experience with 2nd opinions within the department. Seems like its a receipe to make other people look bad and in my opinion kind of throws others under the bus/

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[projectpat]

Post pics and we can compare.

Real talk though… Had an attending in fellowship with terrible needle placement and contrast flow… patients got “excellent relief.” Heavy opioid prescriber.

Don’t sweat it. You clearly care about your technique and results. Onto the next one.

 

[SpineandWine]

Curious what others experience with 2nd opinions within the department are. Had a patient with with a colleague get a lumbar RFA years ago, I repeated it she didnt didnt get much benefit. She threw fit wanted to go back to my colleague which our department typically doesnt do but allowed. I haven't talked to him about it but he repeated the procedure at the same level with signficant benefit. I re reviewed my needle placement and feel mine are very good, Ive done thousands being a few years outside of fellowship and had in my mind a good rate of success. Also looked at my colleagues pics who actualy didnt look as good as mine to be honest, but cant argue with the results.

Im glad the patient is feeling better, but also feel like it makes me look pretty bad. We have PA-s who see routine post procedure follow up, their note was like patient had lumbar RFA with Dr. *** with no improvment and repeat inejction with Dr. *** with great improvement.

Maybe its just a shot to the Ego and I should humble myself, but I I know how to do lumbar RFAs and have lots of patients who do really well.
Just curious about other peoples experience with 2nd opinions within the department. Seems like its a receipe to make other people look bad and in my opinion kind of throws others under the bus/

Don’t worry about APPs- they’re trained monkeys. They’re just documenting it as they see fit. I wouldn’t approach or talk to them about this one instance.

I was self conscious when I started as well. Learn what you can from it re needle placement and move on. I’m sure it’ll come around your way sometime with an epidural or another procedure.

 

[willabeast]

U say "Also looked at my colleagues pics who actualy didnt look as good as mine." Suggest talking to your colleague.He/she might know of a new/different/better technique. Needle gauge? Different RF machine?

 

[SpineandWine]

I know you’d be putting yourself out there (esp since people who never post their own pics unless ideal situation) on this forum will start critiquing.

Would you mind sharing however for learning experience

 

[Agast]

It kind of sounds like you’re saying the patient shouldn’t be allowed a chance to feel better

If someone is opioid shopping that’s one thing. But if a second opinion is not allowed within a group, then that patient is going to leave for another practice.

 

[SpineandWine]

Don’t worry about APPs- they’re trained monkeys. They’re just documenting it as they see fit. I wouldn’t approach or talk to them about this one instance.

I was self conscious when I started as well. Learn what you can from it re needle placement and move on. I’m sure it’ll come around your way sometime with an epidural or another procedure.

EDIT-
I am okay with 2nd opinions on n my group. You “lose” high maintenance patients sometimes. Just create a good rapport with other doc so you two don’t throw each other under bus. Grab a few drinks quarterly and it’ll create a good culture where you would even encourage a second opinion sometime

 

[schmee90]

It kind of sounds like you’re saying the patient shouldn’t be allowed a chance to feel better

If someone is opioid shopping that’s one thing. But if a second opinion is not allowed within a group, then that patient is going to leave for another practice.

lol def didnt say anybody is not "allowed" a chance to feel better. I only have the AP shots of the injection right now I'll have to get the laterals.

Good or bad our practice typically doesnt allow 2nd opinions within the practice. Other place I worked at did allow for this. I get both rationals but wanted to get the groups thoughts.

 

[Agast]

Good or bad our practice typically doesnt allow 2nd opinions within the practice. Other place I worked at did allow for this. I get both rationals but wanted to get the groups thoughts.

If your colleague was the original pain physician to manage this patient, they are re-establishing care. It’s not really a second opinion, if anything you were the second opinion.

 

[Ronin1]

I encourage my patients to get another opinion either in or out of our practice!! Try that tact instead

 

[schmee90]

I encourage my patients to get another opinion either in or out of our practice!! Try that tact instead

curious every run into any problems within the clinic with this?

 

[Ronin1]

curious every run into any problems within the clinic with this?

Lol they all want to stay with me…..

 

[BobBarker]

We trade patients back and forth routinely and also do 2nd opinions if one of us is not making any progress with a patient.

 

[Agast]

The problem is the documentation. No one should be immortalizing patient critique in an office note. My ortho colleague put “patient didn’t care for Dr Agast and wants a referral to a different doctor” in his note, probably because his MA scribed it and he didn’t bother to look before signing.

 

[RoloTomassi]

Depends on your practice situation. If you eat what you kill and your colleague is in a way your competition it can be problematic. But if you think you're better or more personable, an open switching policy can result in net positive patients your way.

If you split the profits equally it doesn't matter just keep the patient happy and in the practice.

 

[MD87]

Curious what others experience with 2nd opinions within the department are. Had a patient with with a colleague get a lumbar RFA years ago, I repeated it she didnt didnt get much benefit. She threw fit wanted to go back to my colleague which our department typically doesnt do but allowed. I haven't talked to him about it but he repeated the procedure at the same level with signficant benefit. I re reviewed my needle placement and feel mine are very good, Ive done thousands being a few years outside of fellowship and had in my mind a good rate of success. Also looked at my colleagues pics who actualy didnt look as good as mine to be honest, but cant argue with the results.

Im glad the patient is feeling better, but also feel like it makes me look pretty bad. We have PA-s who see routine post procedure follow up, their note was like patient had lumbar RFA with Dr. *** with no improvment and repeat inejction with Dr. *** with great improvement.

Maybe its just a shot to the Ego and I should humble myself, but I I know how to do lumbar RFAs and have lots of patients who do really well.
Just curious about other peoples experience with 2nd opinions within the department. Seems like its a receipe to make other people look bad and in my opinion kind of throws others under the bus/

Our policy is both the original doc and new doc have to approve the transfer.

 

[SSdoc33]

the RF wasnt done technically any better, but the patient THINKS it was. placebo. fine. let them go. plenty of other crap to worry about

 

[GlowInTheDark]

Patient autonomy is rule #1

RFAs can fail. Placebo can work. It’s all possible.

 

[BobBarker]

Autonomy is key. I explain this all of the time.

“This is completely elective treatment and my job is to explain to you the likely diagnosis and possible treatments. I can’t guarantee if it will work or not. If you want to do the procedure or not doesn’t matter to me. It is ultimately what you feel comfortable with.”

Or something along those lines multiple times per day.

 

[kstarm]

We have a policy where we don't allow for 2nd opinions. This was initially developed many years ago when most of the 2nd opinions were requests for opioids after one doc said no. Now as we don't have that as much, things have loosened up, and both docs just approve a second opinion. Overall for patients I think 2nd opinions are nice to have, and sometimes my partners think of something I hadn't.