Second Opinions
The WSMA believes that physicians should recommend that a patient obtain a
second opinion whenever they believe it would be helpful in the care of
the patient. When recommending a second opinion, physicians should explain
the reasons for the recommendation and inform their patients that patients
are free to choose a second-opinion physician on their own or with the
assistance of the first physician. Patients are also free to obtain second
opinions on their own initiative, with or without their physician's
knowledge.
With the patient's consent, the first physician should provide a history
of the case and such other information as the second-opinion physician may
need. The second-opinion physician should maintain confidentiality of the
evaluation and should report to the first physician if the consent of the
patient has been obtained.
After evaluating the patient, a second-opinion physician should provide
the patient with a clear understanding of the opinion, whether or not it
with the recommendations of the first physician.
When a patient initiates a second opinion, it is inappropriate for the
primary physician to terminate the patient-physician relationship solely
because of the patient's decision to obtain a second opinion.
In some cases, patients may ask the second-opinion physician to provide
the needed medical care. In general, second-opinion physicians are free to
assume responsibility for the care of the patient. It is not unethical to
enter into a patient-physician relationship with a patient who has been
receiving care from another physician. By accepting second-opinion
patients for treatment, physicians affirm the right of patients to have
free choice in the selection of their physicians.
There are situations in which physicians may choose not to treat patients
for whom they provide second opinions. Physicians may decide not to treat
the patient in order to avoid any perceived conflict of interest or loss
of objectivity in rendering the requested second opinion. However, the
concern about conflicts of interest does not require physicians to decline
to treat second-opinion patients. This inherent conflict in the practice
of medicine is resolved by the responsible exercise of professional
judgment.
Physicians may agree not to treat second-opinion patients as part of their
arrangements with insurers or other third-party payers. Physicians who
enter into such contractual agreements must honor their commitments.
Physicians must decide independently of their colleagues whether to treat
second-opinion patients. Physicians may not establish an agreement or
understanding among themselves that they will refuse to treat each other's
patients when asked to provide a second opinion. Such agreements
compromise the ability of patients to receive care from the physicians of
their choice and are therefore not only unethical but also unlawful. (JC
Rpt C, A-93) (Reaffirmed A-23)
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Abbreviations for House of Delegates report origination:
EC – Executive Committee; BT – Board of Trustees; CPA – Council on
Professional Affairs; JC – Judicial Council; CHS – Community and Health
Services