INSIDE WHEN TO GET A SECOND OPINION

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

Have you heard this one? A man goes to a doctor. “You’re fat,” the doctor says after examining him.

“That’s not what I wanted to hear. I demand a second opinion.” says the man. “OK”, says the doctor, “You’re also disagreeable.”

Sorry. I couldn’t resist the bad joke. However, it does lead in to a discussion on second opinions: when do you get them and what do you do with them. It may come as an unpleasant surprise but your doctor — and I don’t care if he is the greatest practitioner in his field — is neither perfect nor infallible. If you have questions or concerns about your diagnosis or proposed treatment plan, a second opinion is certainly warranted.

Medicine, despite what the bean counters are trying to do with it, is not a vocation that can be practiced using rigid rules and formulas. Each of us is a unique individual who brings this individuality to the medical aspect of our lives just as we do to every other aspect. People can have the same illness but with very different signs and symptoms. Patients may respond very differently to the same treatment program. The doctor/patient relationship is critical because the doctor who questions you, examines you, and truly knows you is really the only individual qualified to offer a diagnosis and suggest a treatment plan.

Most medical problems can be approached in more than one way. Some doctors are very aggressive in pursuing testing for certain complaints or working up every symptom. Others take a more laissez faire approach. Some are quick to recommend surgery if it is an option, while others may do everything in their power to keep patients out of the operating room. Doctors observe certain standards, but within those standards there is room for individual expression.

Doctors are as different from one another as any other group of people. They bring to their practice personal biases and prejudices, as well as differences in their training, life experiences, and professional practices. All of these taken together influence their decision-making when dealing with patients.

Some situations in medicine are fairly clear cut, and the decision making is reasonably straightforward. If you have symptoms of a cold and your doctor recommends bed rest, drinking lots of fluid, and taking some Tylenol, you don’t really need a second opinion from another doctor. On the other hand, if you have a complex, potentially life-threatening condition, then a second opinion from another doctor may prove helpful. Cancer is a very common diagnosis. Some cancers have treatment regimens that have been well established as effective, while treatment for others is very dependent on whom you see.

With accessibility through the Internet to reputable medical institutions’ websites, patients today can do considerable research on their own regarding their medical conditions. It is not uncommon for me to see patients with unusual medical concerns who have a greater fund of knowledge about their conditions than I do. This is not to say I encourage patients to treat themselves. Physicians bring a wealth of education, handson training, and experience to bear in interpreting medical information, evaluating clinical studies, and such.

The time to consider seeking a second medical opinion is when you have a serious and complex condition and your physician or your own research indicates several accepted ways to treat the problem. When discussing your medical care, your doctor is ethically bound to provide you not only with a recommendation for treatment but also to inform you of alternatives. He or she should give you the pros and cons of each option and inform you of the possible risks and complications of a particular plan of care.

You may wish to seek a second opinion for no other reason than you are not fully comfortable with your physician. Patients often become very close to their primary care providers and place great faith in them. When they are referred to specialists, they rely on the recommendation of a doctor they trust. Sometimes, however, this level of trust just isn’t there and a second opinion may help to reassure patients.

Patients who seek a second opinion must be prepared to hear a different recommendation. If this happens — as it sometimes does — you as a patient are faced with a dilemma: who do you believe? Which doctor will you choose to provide your care? Things can become even a little crazy when you seek yet a third opinion to break the tie and the third opinion is different from the first two. It happens!

Another aspect of seeking a second opinion is whether your insurance company will pay for this. They may for certain conditions, but not for others. Contact your insurance representative for clarification.

A final issue is whether you will offend your physician by seeking a second opinion. Good doctors understand that medicine is not cut-and-dried, and they appreciate the concerns and questions their patients may have. They won’t be offended when patients need reassurance. I certainly am not when my patients indicate their intent to do this. My main concern is that they see someone reputable and they understand some of the issues I covered earlier. Many patients feel much more comfortable knowing their physician has no objection to them seeking another opinion and often that is enough to allow them to proceed with the prescribed care without actually getting a second opinion.