We commonly see patients with a problem that is not getting better, following an initial evaluation by another physician. More often than not, the course of treatment has been reasonable. Still, the patient is not better. If our evaluation and treatment is successful, our reputations are the beneficiaries of being second.

Let me give you an example. Bob went to his doctor for a rash. The rash had some characteristics of an allergic reaction, and some characteristics of infection. So, the doctor prescribed an antibiotic for a suspected skin infection. Unfortunately for Bob, the rash got worse. After two days, he sought the opinion of a second physician. Dr. #2 examined Bob and saw the same characteristics of the rash. But Dr. #2 is armed with the knowledge that the antibiotics have not helped at all. So Bob is prescribed medications for an allergic reaction. Thankfully, Bob feels better and the rash resolves.

It isn’t hard to imagine that Bob has more confidence in Dr. #2. But what would have happened if the rash didn’t resolve? What if Bob, now really frustrated, sees a third doctor? Even if Dr. #3 took the same initial actions, he is armed with the knowledge of all the treatments that have failed so far. That information helps him to consider other treatments.

But what if Bob had returned to Dr. #1 and gone through the same process? Dr. #1 would be adding new information with each visit and comparing how things have changed with each treatment. Then, Dr. #1 would be the guy who left no stone unturned until the rash was cured.

So is there a point to this rambling? There are several:

1. A treatment plan doesn’t end with a prescription!
2. Response or lack of response to specific treatment is very important information!
3. At some point, every doctor has been Dr. #1 and Dr. #2, and Dr. #3!
4. Understand your diagnosis and some of the other diagnostic possibilities!
5. Understand the treatment plan!
6. Understand the plan if things don’t go as expected!
7. Discuss 4, 5, and 6 with your doctor, so you don’t need Dr’s #2 and #3.

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