Second opinion

1

• Second opinion

2
Need felt by parents

• Respect the need felt by parents (parents may be
  apprehensive due to previous experience / they
  may feel comfortable with senior doctors opinion
  / they may be pressurized by relatives)
• Cooperate to organize second opinion
• Suggest 2-3 alternate names but accept the choice
  of parents (even any other)

3
Need felt by treating doctor

• Genuine indications
  Disease with guarded prognosis (risk of
  death/ chronic course with high
  morbidity/irreversible damage)
  Disease
  requiring long term treatment Disease
  difficult to control
• Secondary indications
  Parental anxiety/not meeting with parental
  expectations of improvement
  

4
Ideal way

• Choose ideal person for second opinion
  (cooperative, credible, knowledgeable, open to
  discussion, non-exploiting)
• Discuss the problem ahead of time
• Be present at the time of second opinion
• Be transparent about the fees
• Follow the agreed therapy and report

5
Rules for opinion giver

• Never run down the colleague
• Give frank opinion without appearing to be
  against what has been done before
• Spend time to explain the problem
• Take final decision with the concurrence and
  suggestions from the referring doctor
• Avoid subtly direct contact with the patient

6

• Concept of group practice

7
Need for group practice

• Quality maintained with increasing quantity (no
  control over quantity, one cannot refuse a needy
  patient)
• Offers opportunity for problem solving and
  keeping updated / time for family and leisure /
  time for maintaining health
• Shared physical and mental stress
• Academic enrichment

8
Models of group practice

• Multispecialty group practice
• Pediatric super specialty group practice
• General pediatric group practice
• Ideal model - sharing patients, premises and
  profit / Alternate model - sharing premises but
  not patients or profit (keeping assistants or
  locum is not group practice)

9
Ideal model

• Works best on small scale with 3 partners
• Partners preferably of different seniority (6-8
  years difference between each of them)
• Junior partners join the senior with existing
  facility (can be updated with equal share)

10
Ideal model

• Outdoor services run continuously for gt 12 hrs a
  day and part time on holidays / parents choice to
  see any one (genuine second opinion free) /
  different fee structure and seniors
  non-availability incentive for junior

11
Ideal model

• Protocol for management decided together and
  followed by all
• Rational management feasible with equal high
  quality of practice
• Indoor patients are seen 4-5 times a day (with
  single daily charge)

12
Ideal model

• Common lunch time discussion / common academic
  involvement
• Outdoor profits shared unequally (more one works
  more one earns) / indoor profit shared equally
  (rational practice has small indoor profit)

13
Prerequisites for success

• Partners must have same wavelength selection of
  partners most vital
• Senior must promote junior initially (work is not
  split but increases rapidly)
• Manager for administration junior partner takes
  decisions (supported by others)

14
Prerequisites for success

• Ensures happiness that bonds the partnership
  (senior is happy as he gets more leisure and
  junior is happy as he gets more work and earns
  more)

15
Alternate model

• Good for large practice with 6-7 partners MOU
  agreed and signed / equal investment each
  partner responsible for a day / week (24 hours)
  at the hospital
• Outdoor services at individual premises
• Indoor facilities are shared, not patients

16
Alternate model

• Better patient care / sharing responsibilities of
  serious patients / increasing work profits
• Academic activities / training programs possible

17
Shortcomings

• Similar quality and rationality cannot be ensured
  between all the partners
• Varying academic interests and competence
• Dissimilarities may lead to parental preference
  of one doctor over another it may cause
  embarrassment

18
Shortcomings

• With increasing work and profit, not all the
  partners may maintain same enthusiasm
• Larger the number of partners, more is the chance
  of misunderstanding