Not infrequently, I see a patient who's after another opinion. Sometimes, it's after years of seeing other rheumatologists. Sometimes, I'm not even their 2nd rheumatologist or their 3rd. I've been 5th choice on a number of occasions.
These consultations are always tricky and not something I look forward to.
The early thought would usually be: Is it them or us?
Sometimes, it's because the patient's symptoms and complaints can't be worked out. A clear diagnosis may not be possible and discontent leads to more doctors and more opinions. This may be unavoidable.
Perhaps, it's because the patient is "difficult". He or she may not be able to accept their disease or they may not want the options as presented. Us doctors like to use this term, "difficult".
Perhaps, it's us. My colleagues may not have listened enough or asked the correct questions. Maybe we should have tried to marry our clinical goals with the needs of the patient in front of us.
I think that often it's just a case of poor fit. I don't get along with every patient & I know that my style would probably not work for a number of people. Must be the same for my colleagues.
By the way, I'm not offering that as an excuse not to try harder.Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.