Medicine is an "inexact science"; so is the basis for medical management decisions. There are few occasions when physicians are unanimous in their diagnostic or therapeutic approach to a given set of clinical problems. In every day medical management, physicians utilize what knowledge they have to apply to decision making. The sources of this information are (1) Knowledge accumulated during undergraduate training in Medical School, (2) Knowledge acquired during Residency with hands-on training, (3) Knowledge gained during experience as an independent physician. All these three sources are updated from time to time with new medical knowledge as medicine progresses. The three sources of knowledge are the obvious factors in formulating medication opinions and decisions. Yet, there is another "fourth" factor and it is the least obvious one. This factor is unique to each individual physician, as each person makes different judgments and different amounts of risk-taking when weighing risks against benefits. To be exact, it is possible to have two physicians with identical background in three sources of medical knowledge, yet they may have a different diagnostic or therapeutic approach to the same clinical problem in a patient. Take the case of giving a systemic antifungal treatment for a toe-nail fungal infection or a loop diuretic to a patient with ankle edema due to venous insufficiency. These do not look like poor judgements except in the occasional outcome with morbidity or mortality from hepatotoxicity or electrolyte imbalances respectively. In fact, cases like these become defined as iatrogenic diseases when the medical or surgical intervention is worse than the disease. There is no standard by which we physicians can determine the degree of soundness of our decisions. It is possible that the same decision is viewed differently before and after seeing the outcome of that decision.

Asking for a "second opinion" is a way patients use to minimize the difference in the four factors, especially the fourth one. The request for obtaining a "second opinion" should be welcomed and even encouraged by physicians. A second opinion builds up a patient's confidence and trust in the treating physician and lays the foundation for a better acceptance of the outcome of medical or surgical intervention later.

When patients entrust us, physicians, with their lives, there is nothing else in life that matters more! This awesome trust dictates that we use "sound judgement" in medical management decision making as much as is humanly possible, "one life at a time."

Nosshey F. Hanna, M. D.
Member Editorial Board

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About the Author
Nosshey F. Hanna, M. D. is an Associate Professor of Medicine of the American College of General Medicine.

This article represents the opinion of the Author and does not reflect the official policy of the American Academy of General Physicians nor the institutions with which the Author is affiliated.