Expert Opinion| What can you do when your doctors disagree?

When my primary care patient and I discussed her upcoming cardiology visit, she became fidgety and seemed eager to move on to the next topic.

“You seem uneasy about the cardiology appointment. Can you tell me more about it?” I asked.

After a momentary hesitation, she told me she felt confused about differing guidance that she had received from doctors helping to treat her atrial fibrillation (Afib), a common type of irregular heart rhythm.

A month or so ago, she was hospitalized with a rapid heart rate that caused palpitations and light-headedness. She was diagnosed with Afib and started on medication to control the heart rate, along with a blood thinner to prevent stroke, the most worrisome complication. In the hospital, a cardiologist told her that she would need a procedure to restore her heart to a normal rhythm. But later, another cardiologist in the group recommended against the procedure during an outpatient, follow-up visit. The doctors’ disagreement left her feeling anxious and confused.

You may have encountered a similar scenario with your own healthcare. Medical problems often have more than one solution, and doctors may prefer different treatments, based on their experience and specific expertise. As a patient, you may feel like a volleyball being tossed back and forth by medical players.

How can you find your own way when doctors disagree? First, be sure you are part of the decision. The best practice is to engage in shared decision making, during which the risks and benefits of all options are explained and discussed, so you and your doctor can decide together which option best suits your values and preferences.

Even with shared decision making, a new doctor may present an additional treatment option or nuance that makes you feel uncertain. In this case, it is fair game to call this out and mention that their advice conflicts with what you were previously told. Hopefully, you can further discuss the issue with the doctors to clarify things and come to a comfortable, shared decision.

When my patient returned for her next cardiology appointment, she was outspoken about being puzzled over the treatment plan. She learned through further discussion that the doctors disagreed over the timing of the procedure, not the procedure itself. She felt relieved and confident in her decision on the next steps.

Doctors may occasionally tell you that they disagree with a colleague’s recommendation and defend their own. This is where things can get awkward. Your primary care doctor can provide an unbiased perspective and help you sort out the contrasting recommendations. Sometimes, this involves diplomatic outreach to a specialist on your behalf, which may help explain why they do not see eye to eye and point to a path forward. A last resort may be seeking a referral to another specialist — one whose skill and approach is well known to your primary care doctor — in order to start fresh and reconsider all of the treatment options.

Medical decision-making is complex and ever evolving. Disagreement and debate among doctors and other healthcare professionals is normal and healthy. But as a patient, you should be a partner in your medical decisions, and never left to feel like a bewildered onlooker.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.