• clinical neurology

Second opinions are important in neurology. We provide them all the time, mainly through ward consultations but also as outpatient referrals from non-neurological colleagues. And we also frequently seek opinions from neurological colleagues with subspecialty interests. Sometimes a second opinion is aimed at a specific intervention or evaluation—for example, assessment for epilepsy surgery. Perhaps more often it is because we are at a loss: one of our colleagues has a rule to refer if he still does not know what is going on having seen the patient three times, appreciating the benefit of a fresh pair of eyes. But occasionally it is proactive self-defence. A surgical colleague sensing patient frustration or potential complaint advises, “I know just what you need: you need a second opinion.” Getting in first before the patient summons the courage to ask for it promises a happier outcome. …