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SECOND OPINIONS

Misunderstandings frequently arise over second opinion referrals.  However this should be a straightforward procedure which benefits the patient, owner and referral veterinary surgeon as well as the referring practice.  The Royal College of Veterinary Surgeons has laid down simple guidelines which should ensure that difficulties need not arise.

The reasons

Animals may be referred for a second opinion for a variety of reasons.

1.   Because specialised diagnostic or therapeutic equipment is required to confirm a diagnosis, or for specialised treatment.  The institutions most commonly involved with this group are the teaching institutions (veterinary colleges) in the UK, registered veterinary hospitals and specialist referral practices.

2.   To allow a veterinary surgeon with particular experience in one animal species or one particular system to examine the animal and, using his or her expert knowledge, to give a diagnosis and recommend treatment.

3.   In the really baffling case, where a diagnosis cannot be reached or where treatment fails, to allow another veterinary surgeon to pass a second opinion.

It is in the last section that misunderstandings and ill feeling most commonly arise, for generally the second opinion is another veterinary surgeon, possibly in a neighbouring practice, who may appeal to the client more than the original veterinary surgeon.  The client may therefore wish to consult permanently with the second practice.  In  such cases, this is “succession “ rather than second opinion.  Again, a permanent change of veterinary surgeon can be accomplished easily by following the guidelines laid down by the RCVS.  Owners should therefore be aware that by definition a second opinion is strictly that, and that in most circumstances the referring veterinary surgeon would be expected to institute treatment and to maintain progress checks.  The second opinion veterinary surgeon will usually wish to be kept informed of progress, and this should normally be done through the referring veterinary  surgeon rather than by direct contact between client and second opinion veterinary surgeon.

How to arrange (or approach) a second opinion

The suggestion of a second opinion will often be volunteered by your veterinary surgeon who may not have drugs, equipment or specialised knowledge.  If this is suggested, the owner is advised to take that advice and to put him or herself entirely in the hands of the veterinary adviser.

The owner may also request a second opinion if reasonable progress is not being made with the case.  The owner has every right to nominate a second opinion of choice, but generally this should be done only with the full advice of the attending veterinary surgeon who will have a fair idea of the capabilities and limitations of individuals, either in the area or at the nearest institutions.  Thus, valuable time and expense may not be wasted.  A client must not attempt to obtain a second opinion from a new veterinary surgeon without the full knowledge of the previous veterinary surgeon and this, apart from the ethical aspects, has a very sound reason.  Co-operation between referring and referee veterinary surgeons allows transmission of vital information, thus saving unnecessary repetition of x-rays, tests and treatment.  Additionally, the current treatment and any adverse drug reactions can be reported, which obviously is essential for the animal’s well-being.  The referring veterinary surgeon will be expected to supply whatever information is available about the case, including relevant past case history, immediate past case history, including findings, treatment and response, x-rays, laboratory and other test results.

The owner will be required to attend with the animal and only someone who is informed and reliable should accompany the animal during its initial examination, since there are likely to be many questions asked that only the owner can answer certainly.  The owner may well have to be prepared to leave the animal for a period of time with the second opinion veterinary surgeon in order to enable further tests, observation or treatment to be done.

The second opinion veterinary surgeon will communicate with the owner preliminary  findings subject to further tests being done, but fuller details will be given direct by the referee to the referring veterinary surgeon, together with recommendations for treatment.  Unless otherwise instructed, no contact should be made by the owner to the second opinion veterinary surgeon, except through the referring veterinary surgeon.