Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Navigating the path of contradictory medical opinions

Ralph Gordon, MD
Conditions
August 24, 2011
29 Shares
Share
Tweet
Share

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory or even conflicting opinions from your consultants.

Sometimes, the decisions are pretty easy. For example, the patient who underwent a recent cardiac catheterization with the placement of a drug eluting coronary stent is being admitted with a massive gastrointestinal bleeding. The bleeding source is a gastric ulcer with a visible vessel. The gastroenterologist requested to stop Aspirin and Plavix that were given to the patient after the cardiac procedure. The cardiologist insists on resuming both medications as soon as possible to protect the coronary stent from clotting. Your role is to negotiate with the consultants the appropriate timeframe for resuming both medications. The timing will depend on the patient’s condition and the absence of further bleeding.

In other cases the management decisions might not be so clear-cut. A very recent encounter made me think about the contradictions in medical practice.

67 year old female presented with dizziness, nausea, left sided weakness and difficulty speaking. The clinical diagnosis of brainstem stroke was confirmed be the findings on the brain MRI. (See image above with the arrow indicating the site of the stroke in the right pons).

MRA (MR angiography) demonstrated a very tortuous right vertebral artery with significantly limited flow (black arrows on the bottom image above). The left vertebral artery was normal (white arrow on the same image).

The consulting neurologist suspected vertebral artery dissection as a possible cause of the vessel occlusion leading to stroke. The patient was started on anticoagulation, Heparin infusion, per the neurologist’s recommendations.

On Monday morning a different neurologist saw the patient and made completely different recommendations. According to the second neurologist, this was unlikely to be a dissection, but rather an anatomic variability in the size of the vertebral arteries. The Heparin infusion was stopped and the patient was started on Aspirin.

You are the primary attending physician and it is your responsibility to ensure that the patient gets the best treatment for her condition. The most important question to ask yourself is: if the change in medical management compromises the patient’s safety and health.

The review of the literature revealed that yes, indeed, the patients with a suspected vertebral artery dissection are often being treated with anticoagulation. Several favorable outcomes were reported in the literature. Yet, there are no randomized studies available to confirm the benefit of this therapy for the patient with the vertebral artery dissection.

Considering somewhat equivocal results of the imaging study (dissection vs. anatomical variation) and the absence of firm evidence to support the use of anticoagulation, the decision was made to change the medical management according to the rounding neurologist.

There are two questions to consider while navigating the path of contradictory medical opinions. Number one is always what would be safer for the patient – do no harm first. Number two is what would offer more benefit for the patient. The second question is often harder to answer. That is why we consult specialists in the first place.

Ralph Gordon is a critical care physician who blogs at realICU.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

How medical residents should spend their time off

August 24, 2011 Kevin 1
…
Next

An ER specifically built for older patients

August 24, 2011 Kevin 2
…

Tagged as: Hospital-Based Medicine, Specialist

Post navigation

< Previous Post
How medical residents should spend their time off
Next Post >
An ER specifically built for older patients

More by Ralph Gordon, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Pain control in a patient with rib fractures and a spinal cord transsection

    Ralph Gordon, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Do Not Resuscitate and the need for a central line

    Ralph Gordon, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Intubating the combative patient

    Ralph Gordon, MD

More in Conditions

  • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

    Harvey Max Chochinov, MD, PhD
  • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

    Hoag Memorial Hospital Presbyterian
  • The rising threat of lung cancer in Asian American female nonsmokers

    Alice S. Y. Lee, MD
  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Insomnia Symptoms Tied to Stroke a Decade Later
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • Full-On Reversal of Cardiac Amyloidosis Possible With Antibodies
  • Spell Check-Up: Do You Have the Skills to Pass This Spelling Test?
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds

Meeting Coverage

  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Navigating the path of contradictory medical opinions
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...