"Second Opinion" is a great name for a column, and it's also a crucial concept that, I hope, most people now apply when making decisions about their medical care. It's no secret that the demand for health care has mushroomed in recent years and, in addition to the economic pressures this demand has put on the system, caring for this vast population of patients has also cut down on the time that many busy physicians can spend studying their craft. I'm not suggesting that this is leading to any kind of decline in the quality of care. Quite the reverse: new technologies and discoveries are improving medical care all the time. It's just that, depending on the time pressures of their individual situations, physicians of equal skill may be delivering varied levels of care because they are not equally able to keep up with all the new developments in the field.

This may be particularly the case with family physicians -- the general practitioners who must not only practice their own art, but must also know enough about all the other specialties to refer patients to the proper authority when a case is beyond their area of expertise.

In most instances, it isn't necessary for a GP to read a crystal ball to send the patient in the right direction. Most patients with uncomplicated disorders, thankfully, can generally be treated adequately by any qualified specialist once the correct specialty is identified. Yet there are patients and conditions that need care even beyond that of the "general" specialist -- cases that must go to a "specialist's specialist." And, that's where things get sticky.

If a specialist doesn't know how to find a physician using newer techniques, employing the lastest research and giving successful treatment for conditions generally considered untreatable, who will know? And if the specialist doesn't even know, as is sometimes the case, that more sophisticated treatment than his own is available, how will the patient ever have access to it?

This, in my mind, is where the whole hopeful, somewhat magical world of medical high technology is stymied.

My field of specialty is rife with examples and I'm sure it's not unique. I am a vascular specialist treating, for the most part, cases of peripheral vascular disease where narrowing of the arteries in the leg can cut off circulation and eventually lead to death of the leg tissue and the need for amputation. I and others in the United States are performing surgery to bypass blocked leg arteries.

One recent patient's story illustrates how much luck and temerity may be involved in finding the expert you need. Tom had sought help originally when he was having considerable pain and cramping in his leg. His family physician prescribed drugs that would help his circulation.

As the problem worsened and his limb became discolored, he saw a specialist, who recommended immediate amputation. Tom sought a second opinion and entered a community hospital for tests. Physicians there agreed to do exploratory surgery to see if they could open or bypass Tom's artery, but they told him up front that they doubted the surgery would succeed and they asked for his signature on a document that would allow them to amputate right then and there if they could not restore blood flow.

Tom, at that point, was at the end of the line. This was, after all, his second opinion. Yet, he was unwilling to give up, skipped surgery and sought another opinion. It was mere coincidence that he happened to see then a magazine article on improvements in the bypass technique that mentioned my work. Tom is walking again today, and we have no expectation that he will soon, or perhaps ever, lose his leg.

Although Tom's near tragedy was averted, many are not. And there has to be a way to prevent them in every field of medicine.

But, until we of the medical community find a solution, patients should not hesitate to obtain more expert advice. This is the case for a third opinion, but in fact, it may really take a fourth, a sixth, a 10th. A second opinion takes you only to the second level of authority; you must in deference to yourself explore what lies beyond.

If a specialist in your community says that nothing more can be done, go to an urban specialist at a hospital that does research. Find out who's doing the newest work in the field. If your medical disorder is related to age or a condition like diabetes, call the organizations representing those groups and the editors of publications geared for them. Talk to anyone you know who has or knows someone with the same condition. Talk to anyone you think might point the way.

In this complex world of vast but elusive medical knowledge, it is not how many opinions you get that is significant, but how many you need.