second opinions
Not an option - a necessity
When you are making a major decision in your life, chances are you do not rely on just one source of information. The same holds true for your health. As a “ consumer” of your medical care, seeking out more information and opinions on your diagnosis and treatment can help you make more informed choices. This is important if you are not feeling comfortable with the first opinion you received, but is also important any time a major diagnosis is given. While much of the time routine medical care is just that; other times we require calling in the cavalry. If you or someone you love is presented with a dreaded diagnosis, you need to be sure the diagnosis is accurate. A second opinion is a chance to gain more knowledge and insight into the accuracy of the initial diagnosis, which can only help to refine the treatment options. It is not like there is pain involved as many times retesting isn’t necessary because existing digital copies of labs, films and actual slides can be reexamined. Even with problematic diagnoses, many of us still resist making the effort to get a second opinion. It may be one of those movies we make up in our heads that follows an imaginary story line that what we don’t know won’t hurt us, instead of the reality where knowledge is power.
Second opinions on important health care matters can provide peace of mind. Even if it feels "funny" to us to request a second opinion, it is standard medical practice. Real life doctors expect their patients to seek second opinions on serious matters. Physicians welcome another set of eyes and thoughts on their diagnoses and appreciate the confirmation when it is offered with respect and thoughtfulness. Many physicians will suggest the names of other specialists to talk to, without even being asked. They understand it’s not a popularity contest, but a fight for survival requiring information. If your provider doesn’t comprehend that fact, it is a bright red flag letting you know you are with the wrong provider. Neurologist Orly Avitzur, MD says, “When a patient tells me she wishes to talk to another doctor, I try to be as helpful as possible. A fresh set of eyes on a diagnosis can never hurt, and I want my patients to see me as an ally in their health care, not a hindrance.” This is the kind of open-mindedness and trust we must recognize as being important and an integral component at the heart of our relationship with our physician. This reasoning holds true for whatever ails you – seeking opinions and options is essential for any medical or surgical procedure; the goal is the same - getting the treatment that is best for you long term.
Despite the many advantages, second opinions can be daunting to some patients who feel they may offend their doctors, that the process will take too long, or be costly. You may wish to ask yourself:
- How serious is my condition and this decision?
- How big of an impact will this decision have on my life?
- Do I have doubts about what I am hearing from my doctor?
- Would I feel better if I consulted with someone else?
- What are the pros and cons of getting a second opinion?
For those who don't seek out second opinions, the answer may be as simple as not wanting to hurt their doctor’s feelings; yet any physician who would have hurt feelings over a patient who has questions and wonders about what might be on the other side of the rainbow, is not the physician you want - or need. Your physician should want the best for you and if something new or different is learned in the process of speaking with someone else, so much the better. Even in instances where we think a second opinion is a good idea, many of us worry about how to broach the conversation with our doctor. However, it is really quite simple; once you take the emotion out of the question, just ask your physician who they would recommend for a second opinion. By taking the drama out of the situation you show an appreciation and respect for your physician’s opinion and recommendation. Their willingness and knowledge about who to recommend may help you feel more comfortable, not only with the process, but with the physician who provides the second opinion as well. Once you have decided to seek a second opinion here is a recommendation on how to raise the subject with your doctor: “ This is a big decision for me and to be sure I have all the bases covered, I would like to talk with another expert about my treatment plan and my options. Can you please help me with this? Who would you recommend I see?"
Seeking a second opinion doesn’t mean you won’t be back; it may well mean you will return a more committed and engaged patient, which, as the data on health improvement tells us, is always a good thing. Some who are second opinion adverse might feel it is too far to travel or just plain inconvenient. And yet many of us routinely drive out of our way to go to our favorite Trader Joe’s or Costco. remember, extra miles, hurt feelings or wounded egos have no place in the realm of second opinions. In addition to seeking your physician’s guidance on a second opinion provider, you also need to know how sure your physician is that you have what he or she thinks it is and whether there is there anything else it could be, or even if there is something else that could be contributing to the findings making it seem like it is one diagnosis when really it is another. Therefore, whatever you do, confirm that your diagnosis is the proper one;everything else follows the diagnosis, it is essential to get it right before treatment begins. This is where a second opinion really matters, because even when providers agree on the diagnosis, the variability in their treatment options may be enough to switch you from one caregiver to another. Like much of life, in medical care as well, there is generally more than one road to follow; it‘s why different providers may, in fact, prefer different approaches. It is useful to find out why a provider is recommending what they are suggesting, and to establish what the implications of their approach is for you. Remember also to ask follow-up questions about the quality of the lab tests or x-rays or whether there are there any other tests you should have to clarify and provide more information.
A recent Gallup poll found that 70% of patients feel so confident in their physician’s advice that they don’t seek out another medical opinion. And yet, researchers at the renowned cancer center M.D. Anderson Hospital in Houston, report that upon review, upwards of 65% of pathology slides are misdiagnosed – yes, more than 65%. As Malcolm Gladwell illustrates so graphically in The Tipping Point, a minimum of 10,000 hours are necessary to become an expert, no matter what field is in question: aeronautics, computer programming, professional sports or medicine. While physicians routinely get in more than their 10,000 hours of training, it is not always in the differential minutia of cells that can go awry in oh-so-many ways. Sometimes you just need that expert who knows the nuances and the potential pathology of what the slide reveals to make the distinction between closely related diagnoses that may have vastly different treatments.
A wrong or missed diagnosis is a problem none of us can afford to have when we are really sick. You don’t want to be the patient who receives treatment for a disease you don’t have, only to get sicker as the real disease process goes unchecked. Needless to say, a missed or wrong diagnosis can cause undue harm and heightened anxiety levels. According to oncologist, George Daneker, Jr. MD, “More advances in cancer treatment have been made in the past five years than in the past fifty. That means more options for patients when they’re making the most important decision of their lives.” In light of all the recent scientific advances, it is hard to keep up on all treatment options. This has become even more of a reality as the use and availability of personalized treatment plans based upon precision and targeted medicine become more and more widespread.
Sometimes it turns out patients fear a second opinion for fear of having to have to go through the same tests again. In our computer age, second opinions are also offered electronically by some large medical centers like Johns Hopkins and the Cleveland Clinic. Think about it, you want to be 100% sure that your diagnosis is the right one and not part of a larger problem that goes unrecognized as your physician is thrown off the scent by following a course of treatment that may not address the underlying primary problem with the result that something that could have been treated earlier successfully, becomes too advanced or resistant and results in a less than favorable outcome.
Once you have made the decision to go forward with a second opinion, it is important to know that preparation for this appointment will take some time. While it may not be easy when you aren’t feeling your best, you have to do your homework. Check out the internet to see if your provider has published any articles or done research in your diagnostic area, it is a good starting point of connection and conversation. Don’t be afraid to let the physician know how important this diagnosis, surgery or procedure is to you. Physicians respond to the same courtesies as you or me, so there is no harm in complimenting them as to why you are there and how you found them. It is also a great idea to ask simple questions to ensure that you have been presented with all the options. With surgical second opinions it is important to ask about the number of cases they have done, and what their complication and success rates are as well as their infection rates and the length of time they anticipate you will be in the hospital or outpatient surgery center. The rule of thumb for complex procedures is that the physician performs 350 procedures a year to be considered at an acceptable minimum level.
There are a few simple questions to ask any physician you are considering for the privilege of treating you. For example, begin with asking how many cases of this they have seen or treated or how many of these have you done? These are objective questions that lack drama and are easily quantified and answered. If the answers aren’t ones you are comfortable with, the decision to receive your care elsewhere is no longer subjective and becomes based on an objective, reasonable analysis. It is never unreasonable to want to be somewhere and with someone who has seen and managed problems like yours before and consequently knows where the pitfalls may be hiding. After all, everyday shouldn’t be Groundhog Day when your health is concerned. There is never a good reason to repeat the same mistake instead of learning from them. Based on his years of experience helping patients, patient advocate Leslie Michelson tells us, “For every disease, there are experts.” Conversely, based on this same experience, he wisely warns us, “Never risk your well-being by putting it in the hands of someone for whom your condition is a novelty.”
A second opinion is a chance not only to confirm your diagnosis and to seek treatment options, but also to gain insight and understanding about collateral treatments like nutrition, side effect management and the development of support systems. It is not surprising that many times second opinions are solicited after a diagnosis of cancer. In response, the Cancer Treatment Centers of America developed the following helpful list of 10 questions that patients should ask when considering treatment:
- What types of diagnostic testing do you perform?
- What does my diagnostic testing tell me?
- What treatment options are available? What do you recommend and why?
- What happens if a treatment approach doesn’t work for me?
- What are the side effects of treatment, and how often do your patients experience them?
- How will you help me manage side effects?
- How many patients have you treated with my type and stage of cancer, and how successful have you been?
- Who will be involved in my care, how often will they meet and who is my main point of contact?
- Where will all of my treatments, appointments, tests, etc., take place?
- How will you help me balance my cancer care with the demands of my normal life?
If these straightforward questions aren’t answered to your satisfaction, remember you do have other choices; it is always important to find a facility and a health care team where you will be comfortable.
Once you decide on a second opinion, check with your insurance company to confirm coverage.
Additional resources
Web MD - How to Ask for a Second Opinion
Mayo Clinic - Value of Second Opinions
Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine by Jerome Groopman, MD