Offering an honest (but careful) opinion

Ethics Forum. July 7, 2003.

How much should you tell the patient about her chosen surgeon?

A patient comes to you seeking a second opinion after being told by another surgeon -- notably the worst in town -- that she needs bypass surgery rather than angioplasty. Although you agree that the patient does need bypass surgery, you don't think that the surgeon she has lined up should do it. What are you ethically obligated to tell this patient?

Reply:

This case raises several questions. The most important one is: Should I share my assessment of the other surgeon with the patient? Related questions are: How accurate are assessments of another surgeon's abilities? Should I worry about harming my relationship with the other surgeon? What is the best way to share such information with the patient?

To address these various questions, I must first consider some basic assumptions. It is not enough for me to have some vague sense of the other surgeon's reputation. If I am to consider sharing my assessment of another surgeon's ability with a patient, I must be certain that I have specific knowledge of that surgeon's abilities.

If the other surgeon is recommending an operation for which he or she has no training, I have an obligation to share my concerns with the patient. However, if the other surgeon is one of 10 in town who are trained to perform the operation and he has a slightly higher (although fully acceptable) complication rate compared with the other nine, I do not have an obligation to share that information with the patient.