The Epilepsy Program at Neurological Surgery, P.C.

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(excerpt from "The Essential Patient Handbook"; Ettinger AB and Weisbrot DM)

Despite a physician's best efforts, there are times in which a definitive diagnosis cannot be achieved. Lack of a diagnosis can be very unsettling, and the comfort levels of physician and patient in this situation can be very different. In the absence of a firm diagnosis, some people may still be relieved that serious conditions have been ruled out. Others worry that this means a serious illness is still lurking out there, waiting to cause medical havoc at a later date. Sometimes, the unsettling feeling is so intense, that it feels preferable to have a bad diagnosis than no diagnosis at all. These are all commonly encountered reactions.

If your doctor cannot render a diagnosis, there are several possible explanations. The least likely possibility is that an unusual new kind of disease has recently developed. More likely is the possibility that your physician does not deal with that particular medical problem on a regular basis, leading to unfamiliarity with the nuances of your case. Indeed, with the explosion of advances in medicine, it becomes increasingly difficult for your physician to stay on top of so many different areas of medical science. Alternatively, the physician may be pursuing the wrong direction in diagnostic reasoning or has failed to recognize some crucial findings. Regardless, when the diagnosis is unclear, it is very appropriate to get additional opinions involved. Many fine physicians will spontaneously suggest getting another opinion at that point, and may provide names of experts that deal with this particular problem. Physicians who do so should not be viewed as conceding defeat or displaying lack of ability; rather, these are responsible doctors who place your health as the top priority. If your doctor does not suggest a second opinion, it is appropriate to ask about it.

Don't Worry, Its All in Your Head!

Second opinions are not only helpful when a diagnosis is unclear, but sometimes should be considered even when a diagnosis is rendered (e.g., when major decisions hinge upon an accurate diagnosis, or when symptoms persist despite recommended treatment). Second opinions are also appropriate when symptoms are dismissed as purely psychological in nature, especially if this diagnosis is given in the absence of reasonable testing. The medical literature is filled with terrible stories of missed diagnoses attributed to purely psychological causes. Although there are indeed psychologically-driven symptoms, this conclusion should be made only with great caution and after very careful evaluation.

Your Doctor Should Welcome a Second Opinion

The second opinion can give fresh insights or further clarification about the diagnosis, lead to different diagnosis, or bring about similar conclusions on diagnosis but suggestions for other treatments. Rather than a statement of poor confidence in the original doctor, second opinions should be welcomed by patient and physician alike, to help both deal with the medical symptoms. For example, second opinions can end up reinforcing confidence in the recommendations of the first physician. Sometimes, an arrangement can be made between physicians in which the local physician manages the day-to-day problems but confers with the specialist as needed when specific difficulties arise. This is both gratifying for both doctors and comforting for the patient.

At the North Shore-LIJ Comprehensive Epilepsy Centers, we are pleased to offer 2nd opinions in the area of epilepsy and related disorders. We are delighted to work together with your referring physician in rendering the most optimal diagnosis and treatment plan.

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