Orthodontic “Second Opinions”: What They Sometimes Are, What They Should Be

Second opinions in orthodontics can be of significant benefit to adult orthodontic patients (whether prospective or already under treatment) and to the parents of young orthodontic patients. They can amplify or clarify treatment recommendations, serve as cogent and ethical commentary on the quality of treatment, and inform parents and patients about the benefits, risks, and long-term implications of specific treatment options. The quality and value of a second opinion should be rooted in an expected high level of technical competence, critical thinking, and accepted orthodontic treatment standards. Above all, the second opinion should be firmly grounded in professional and ethical integrity.

Regrettably, what should be the delivery of a potentially valuable professional and informative service often turns into a veiled and frequently transparent attempt to solicit a prospective patient into the practice of the individual performing the second opinion. Instead of being informed, the patient or parent is now steered. Such shabby “second opinions” reflect poorly on the integrity of the clinicians rendering them, the specialty of orthodontics and the dental profession. They intentionally or unwittingly undermine the public's perception of our educational and ethical foundations.

From a practical perspective, other consequences of such “second opinions” include the unjustified discrediting of colleagues, fanning the flames of potential patient/doctor conflicts, and, in some cases, initiating litigation that is without merit. It is my observation over the past 31 years of dental practice that, more than infrequently, these clinicians are the ones who continue to render dubious “expert opinions” for plaintiffs' attorneys. These “hired guns” may profess to represent legitimate patient advocacy, but may also have a vested interest in the concept of “you pay, I say.” It is our obligation to give responsible opinions in the office or the courtroom to insure that the patient's best interests are being protected. Our learned opinions should not be for sale, and there should be some accountability for those clinicians who abuse or ignore these professional responsibilities.

Like most colleagues, I have always looked upon the opportunity to render a second opinion as a professional responsibility that will reflect upon our academic and professional ethical standards. Sometimes this is a singularly difficult challenge, because previous treatment outcomes might have fallen short of the patient's expectations or current standards of professional care. I purposely try to avoid the impression that I am actively or surreptitiously soliciting or steering a patient into my practice. Perhaps the best way to remove significant bias from such an encounter is to inform patients or parents that you are available to render a second opinion, but not available to engage them or their children as patients in your practice. It would be interesting to see what difference this concept might produce with respect to more credible and valuable second opinions. I would imagine that this new model of second opinion rendering might very well result in a better-informed parent or adult patient capable of making a more educated choice between the orthodontic treatment options presented. Perhaps our professional organizations would consider endorsing such a policy as a recommended practice where applicable. If so, the orthodontist and the specialty will render a meaningful and ethical service to the public.

It is appropriate for members of our specialty to insure the professional and ethical rendering of the second opinion process in our communities. These bioethical principles should be included early in postgraduate orthodontic education, modeled as routine practice in the clinic, and reinforced by both the orthodontic specialty and the dental profession. By doing this, we will indeed be serving the public, individual patients, and the parents of young patients in the most valuable and ethical manner. Nothing less should be our goal.