The Value of a Second Opinion

The Value of a Second Opinion

… cannot be underestimated.  In the case of Charlie Gard it could mean the difference between having his life support machine turned off, and being given the chance to receive an experimental approach for his rare disease.

You will note that I deliberately avoid using the term “treatment” because until the experimental approach has proven efficacy (effectiveness) it should not be termed “treatment”.  However, all currently approved treatments have gone through a stage of being considered unproven, and experimental.  I can think of drugs like Gleevec, which were given to patients at death’s door. Some of these patients made remarkable recoveries after receiving the experimental approach.

Why is a second opinion valuable?  Because physicians are humans, and humans make mistakes. Charlie Gard’s parents have understood that it is appropriate to have a certain amount of skepticism when receiving medical diagnoses and prognoses. There are numerous examples of medical prognoses being wrong. Patients have woken out of comas after years of being unconscious. Miracles (unexplainable turn of events) do happen even in our technologically advanced world.

In the US there is a tradition of seeking a second opinion when one does not like or agree with the first one.  I know of a number of cases where the second opinion probably saved lives.    In the UK, this insistence on a second opinion is, in my view, quite unusual. This could be why, Great Ormond Street have fought back. I doubt that their prognoses have been challenged to this extent so publicly before.

While it is important to seek a second opinion, particularly in life and death situations, it can be difficult to obtain an independent second opinion uninfluenced by the first. In a situation such as this, the physician being asked for a second opinion would tend to be swayed by the standing of the physician or institution that gave the first opinion. You can imagine that few pediatric physicians in the UK would be comfortable criticizing or being seen to critique a prognosis  eminent physicians at Great Ormond Street Hospital  Dr. Michio Hirano is the physician that has been tasked with examining Charlie Gard and giving a second opinion.

What characteristics and qualifications are desirable in a physician giving a second opinion?

  1. He or she should be eminently qualified in the disease area on which the opinion is being sought.  TickDr. Hirano is eminently qualified. He specializes in neurological conditions such as Mitochondrial Depletion Syndrome, and is a physician scientist on top of that. He not only treats patients, but is also qualified to conduct research on the causes of diseases and to study new potential treatments. 
  2. He or she should be able to exercise independent thought. Tick – Dr. Hirano held his own under cross examination at the High Court. He was respectful but was not cowed by the high profile nature of the case.
  3. He or she should be able to express this independent thought without apology. TickDr. Hirano expressed the view that he has seen no evidence that Charlie Gard is in pain. By the way, would turning off the life support machine not cause Charlie pain as he is allowed to effectively suffocate?
  4. He or she must be able to examine the patient without being swayed by evidence already presented by the institution that gave the first opinion. Tickthis confidence and independence was evident during the interaction with the Judge and QCs last week.

I believe Charlie has a real chance of being given an independent second opinion by Dr. Hirano. I am pleased that he has managed to remain anonymous until now.   For the sake of this Baby, I hope that he will be allowed to do his job without endless distractions and side stories about him, his practice, his family and his previous patients.

 

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