Getting a second opinion

Diagnosis and treatment of disease can be difficult. Although a correct diagnosis and successful treatment are what we hope for, when dealing with animals, however, the signs of illness may be unclear and not every case will respond in the same way.

If a safe diagnosis cannot be reached, or if treatment is unsuccessful, a second opinion may save time and expense. Usually this is agreed by vet and owner, but sometimes the lines of communication break down.

New pair of eyes

Second opinions may involve re-examination, but can be restricted to scrutinising X-ray plates or laboratory results. A new “pair of eyes” with different experience and expertise can be useful. Most vets welcome the help of a colleague in solving difficult or unusual cases.

Cases which have been well-managed by both vet and owner are often referred to the Philip Leverhulme Hospital at Liverpool University for a second opinion because of long and frustrating delays in recovery.If the vet wants a second opinion, the owner might think his vet does not know what he is doing. Diagnosis and treatment are based on both theory and experience.

On the other hand, the vet may think that an owner who asks for a second opinion is criticising his ability- usually, the owner is simply worried about his horse. A good working relationship between vet and owner can avoid these potential difficulties. They often reach a mutual decision to seek a second opinion when the case is difficult or is not respondingas expected.Second opinions are also sought when the vet does not have the physical resources to explore the diagnosis further.

Devious ways

The surreptitious second opinion is fairly common. An owner will ask a second vet to examine his horse without revealing that it is being treated by another. Not only is this discourteous to the first vet, but it can also present the second vet with a serious ethical problem. Follow the rules. Ask your vet to arrange a second opinion; equally, do not be concerned if he wants one himself.

Specialist help

Tell your vet if you have a second vet in mind, if not, he will know the best person to contact. A second opinion from a practice colleague is easily obtained. Arrangements are usually made with other practices or specialist centres by letter or telephone and the results will be sent to your vet. Sometimes, the treatment is carried out by the specialist or he will suggest a treatment for your vet to try.

A second opinion might be needed from a physiotherapist, nutritionist or chiropractor. Co-operation between the professions is important here. Owners cannot expect the vet to have specialist knowledge about every possible disease.The charges for second opinions dependon the type of opinion being sought. Referral to a specialist centre is likely to be more expensive than an opinion from a practice colleague

Nosebleed

A vet was called to see an eventer with a nosebleed. Although the owner thought it was going “over the top”, she sought an immediate second opinion from a colleague from a neighbouring practice who had an endoscope. Together, they examined the horse. The blood was coming out of the guttural pouch and they made arrangements for admission to the hospital at Liverpool University.

The horse was diagnosed with a fungal infection of the pouch. Emergency surgery was performed that evening and the horse recovered fully.Without the second opinion, the horse might have suffered a fatal haemorrhage over the next few days. Prompt attention resulted in a healthy horse.

Cut fetlock

A horse suffered a cut over the fetlock, but it did not bleed and did not look the sort of thing for which a second opinion was needed. However, the vet explained the reasons carefully. A specialist second opinion confirmed that the joint was open and infected. The prompt approach avoided a potentially catastrophic outcome.