(light music)
- There are a couple of ways that people come
to second opinions.
One is when someone has been told,
"There isn't a solution to your problem."
That is very difficult to hear.
Unfortunately, sometimes it's true,
but also sometimes it's not.
Sometimes the solution may depend on technology,
and there may be technology in one hospital system
that is not available in a smaller
or more rural hospital system.
The second thing is,
sometimes the patients get a sense
that things aren't completely clear.
And they maybe don't feel like they're getting the answer
or complete answers that they want from their caregiver.
Its perfectly appropriate for them
to independently reach out and say,
"Can you please confirm this for me?"
or, "What is your view?"
I commonly tell my patients to get second opinions.
I recommend them,
particularly when we're talking about difficult paths,
difficult treatment strategies,
difficult risk assessment.
I will often recommend people that I respect
and suggest that patients will seek a second opinion
to improve their own understanding
and make sure that we're really doing patient-centered care,
what's best for the patient.
Medicine is an art.
It's not always a linear process.
It's not adding up numbers and coming to a conclusion.
These are many subjective variables,
and different physicians with different levels of experience
or perhaps different training
can come to different conclusions.
These would then be confirmed with some objective test.
It's always appropriate to make sure you're looking
at a problem from all of the angles,
and having second opinions from different specialties
or different levels of specialty
is perfectly appropriate and should be done
anytime there's a question.
It's not a trust issue at all.
And in fact, I, as I mentioned,
I commonly recommend patients will get a second opinion
for difficult or problematic cases,
just because I wanna make sure
that the patient is comfortable with the conclusions
that I've reached,
that others will confirm those conclusions.
And this is just a chance to get confirmatory evidence
that yes, we're on the right track, yes, we agree,
or perhaps there's an alternative diagnosis
or an alternative solution that may not have been presented
and patients can get more information.
Getting more information is never the wrong thing to do.
At Ochsner, we have sub-specialty care.
Many times in the community,
a cardiologist will do stress tests on Monday,
cardiac catheterizations on Tuesday,
they'll see patients in the office on Wednesday,
and go back to read echos on Thursday.
They put in a pacemaker on Friday.
They are able to do the complete spectrum of care.
At Ochsner, we narrow those specialties down
so that, for example, I'm an interventionalist.
I only work in the cath lab.
I focus all of my activity in the cath lab.
We have other doctors who are completely focused
on heart failure.
We have doctors completely focused on arrhythmias.
We have doctors completely and narrowly focused on imaging.
So, nobody at Ochsner really does the whole thing.
We all do pieces of it and we go deep.
And that is what differentiates our practice
from the standard community practice.
Again, the virtual second opinion
has the benefit of being extremely convenient
for the patient, being readily available.
There is very little wait or lag time
between requesting a video second opinion
and seeing the physician,
as opposed to an in-person visit,
which requires travel, time, and oftentimes,
there's some delay in the in-person visit.
Once I've seen you on a video visit,
I can much better decide if I need to see you tomorrow,
as opposed to in one week or two weeks.
And so the physician can do what we call pull you forward
if they think that that is appropriate,
if there really is some need for urgency,
the video visit is a great way to kick that off.
It also establishes a relationship.
Much of patient care is the relationship
between the physician and the patient.
They're people.
And in a video visit,
you can decide whether you really like, trust,
and wanna work with that person.
So it's a great way to test things out
without having to make the full commitment
to come for an in-person visit.
There's a theme called de-escalation,
meaning that we can take patients who have been recommended
to have bypass surgery, for example,
and during a second opinion or a video visit,
we can decide that maybe that patient
can be treated with stents without an open-heart surgery.
So, we can go through a process.
We have a mechanism to determine the level of ischemia
and the kind of problems they have
and whether it is safe to de-escalate
from bypass to stents.
By the same token, sometimes we can de-escalate a patient
who's been recommended to have stents
to be managed with medical therapy.
And this is truly helpful to patients
because avoiding procedures that may be unnecessary
or procedures that may not benefit them greatly
is avoiding a lot of harm or potential harm.