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Excerpt from the Prologue of Second Opionions

      I make no pretense of omniscience. Decisions about diagnosis and treatment are complex. There are dark corners to every clinical situation. Knowledge in medicine is imperfect. No diagnostic test is flawless. No drug is without side effects, expected or idiosyncratic. No prognosis is fully predictable.

      Still, there are important landmarks that help doctor and patient successfully navigate this uncertain terrain. A clinical compass is built not only from the doctor's medical knowledge but also from joining his intuition with that of his patient. This melding of minds occurs when the physician probes not only his patient's body but also his spirit, considering not only the physical repair required but also the psychological and emotional needs. Eliciting a patient's intuitive snese of his condition is not simple. It takes time and open dialogue to build trust with a person and to encourage him to express himself.

      I wrote this book to provide and inside view of the complex and rapidly changing world of medicine and thereby help people make informed decisions. While there are no pat guidelines applicable to every patient and every situation, the chapters that follow retell critical moments that have forever shaped my thinking and practice--not only for my patients but for my family and myself. It is these times--both when my opinions and actions proved right and when I seriously erred--that I have sought to portray in the clinical dramas which occurred around me.

      ...Some choices are urgent and the consequences immediate. In the ER or operating room, decisions can spell life or death within minutes. My firstborn son, at ten months of age, developed an intestinal obstruction and almost died due to physician misjudgment. His story opens the book. Other chapters highlight seemingly minor decisions, made in less urgent circumstances, which proved to importantly determine the health and welfare of a person--their effects do not manifest for months to years. I also recount instances when I had no clear understanding of what was happening clinically. Nonetheless, choices of great risk had to be made.

      ...It is my hope that the stories in this book will enable the reader to make medical choices--his own, or for family or friends--with greater knowledge and deeper intuition, thereby contributing to the remedy of illness and enjoyment of heath.