My child sees another physician. Why won't you give me a second opinion by e-mail?

We frequently get e-mails regarding health issues of children we've never seen. We definitely want you to get the best advice you can for your child, but we don't feel qualified to provide it for children outside our practice. Here are some reasons why:

  • We have no old records available to review. Looking at a child's old records -- to see a previous pattern of illnesses, medication history, growth charts, and developmental history -- is indispensable in pediatrics. Without this background information, it's impossible to give good advice. While parental reports of the problem can be useful, they are not a substitute for a physician's medical record which provides complete documentation.

  • We haven't examined the child personally. Without personally seeing the child and assessing him, our advice would be primarily an educated guess only.

  • We want to avoid the "too many cooks" phenomenon. Some doctors approach the same problem differently. There may be more than one correct answer to a problem. However, getting snatches from advice from different doctors, without one doctor comprehensively overseeing the patient's care, is like the old proverb, "Too many cooks spoil the soup." Parents are often left frustrated, not knowing which source of information to trust.

  • Legal reasons. Physicians who dispense advice or prescriptions to patients they've never met, especially out-of-state patients, have been prosecuted for practicing medicine without a state license in the state where the patient resides. Also, we cannot respond to people who have not signed an e-mail consent form in our office.

But I'm not sure I trust my child's regular doctor, and/or I'd like to get a second opinion.

Then by all means, get a second opinion. But first, in your next visit to your regular doctor, explain your concerns to him or her. Try to describe exactly what concerns you: Are you afraid your child's symptom could be the sign of something fatal? Do you think the symptoms are more severe or lasting longer than is typical? Do you need reassurance that your child's symptoms aren't that rare or unusual?

Most good doctors don't feel threatened by a parent's desire for a second opinion as long as the second opinion will be coming from someone who's more, or at least equally, knowledgeable. For example, if you need work on your car done, go to a reputable auto mechanic -- not a general handyman who tinkers with cars. Get your second opinion from a pediatric specialist who will speak with you and examine your child -- not from a non-physician, a parent with "something similar" you met on the Internet, or a physician who doesn't have much experience with the problem in question. And be sure to let both doctors know that you've seen the other -- the doctors may want to discuss your child as well, and share information.

Can you recommend a second-opinion doctor for my child in my area?

There are lots of great pediatricians and pediatric specialists out there. In general, we have found that board-certified pediatricians who are members of the American Academy of Pediatrics have the best, most up-to-date information. Some non-pediatrician physicians may not have the training or experience to deal with the unusual or complex problems of children. Most family practitioners spend about 4 months of formal training treating children. Most general practitioners and internists have had no formal training with children, outside of what they learned as medical students. (By comparison, pediatricians spend their entire 36 months of residency focusing on children, with over a year spent just on very sick children: hospitalized children, ICU care, neonatal intensive care, etc.)

Pediatric subspecialists should be board-certified in pediatrics and in the pediatric subspecialty in question. We have found that adult subspecialists (e.g. cardiologists, gastroenterologists, etc. whose training was in internal medicine, not pediatrics) are generally less experienced in the special problems and treatment of children. Typically, their formal training primarily focuses on adults and is limited to only 1-2 months of working with children.

If you live in a medium-sized or large city, there may be a medical school or teaching hospital in your area. Pediatricians with teaching appointments at medical schools and residencies are among our finest clinicians. Because these doctors teach other doctors, they are held to very high standards. Other doctors tend to refer particularly severe or problematic cases to them, so they have a wide experience with unusual problems. These physicians are usually the ones participating in ongoing medical research and have the newest and best information.