By Paul Goldfinger MD, FACC Reprinted with the permission of the author.
People understand that getting a second opinion might be a good idea in certain medical situations. The hard part is to know when to request one, whom to see, and which opinion to believe.
If something wrong is being done in the care of a patient, obtaining a second opinion by a competent doctor should correct the problem. If you are a patient and you or your family suspect that something untoward is occurring, then you need to request a second opinion. You may feel uncomfortable asking that another doctor be consulted, but it is your right, so do not be intimidated. A quality doctor will welcome a second opinion. Ii used to welcome second opinions because most of the time I am proven right.
Sometimes a doctor will suggest a therapeutic plan, such as surgery, which might be an acceptable approach, but you may wonder whether there is a different solution. You should ask for a second opinion, but the fact is that two or more competent doctors can look at the same data and come up with different opinions, all of which are correct.
An example relates to the use of coronary bypass surgery, a treatment that has been available for over 50 years. Despite widespread use of this technique to treat heart disease, there is still controversy about when to recommend the procedure.
Consider the results of a poll of 7,632 health professionals by the New England Journal of Medicine regarding the proper care of a 67 year old man with stable heart disease and intermittent chest pains. All the doctors polled were given the same medical data and were asked to choose one of three possible treatment options: bypass surgery, angioplastly/stent procedure (PCI), or medical therapy (drugs, diet, exercise, etc.).
Of the votes cast: 43% favored medical therapy; 40% preferred bypass surgery; and 17% recommended PCI. Based upon the knowledge current at the time, all those doctors were correct. Those who participated were from 111 countries and regions, and 85% were physicians. The rest were medical students or other health professionals.
The Journal concluded that the choice of treatment in this case was “controversial” and that more research would be needed. So, this patient could get a second and then a third opinion and wind up with three correct but differing recommendations. What to do?
It is less than ideal, but the patient and his family will have to consider the evidence presented to them and then make a choice. For many in such a situation, the decision boils down to which doctor they trust the most and what is the patient’s preference. Sometimes the primary physician can help. When you see a second opinion doctor, ask him/her to discuss all the options and then to make a specific recommendation.
Second opinions are used for other reasons in addition to errors or controversy. Sometimes an insurance company will mandate a second opinion before they will pay for surgery. Second opinions may also be requested by the physician himself if he is unsure about his diagnosis or treatment. Other reasons to get a second opinion include: life threatening situations, complex cases, or the suggested use of “off label” medicines or experimental therapies.
When it comes to the choice of a doctor to perform a second opinion, you can ask your physician to suggest someone, but the person chosen must be a doctor who is acknowledged as an expert in your community. If the situation is serious, and if the circumstances permit, you might want to see a consultant at a major medical center, such as one run by a medical school, even if you must travel to New Brunswick, New York, Philadelphia or elsewhere.
I love the radio commercials by Dr. Mehmet Oz, a cardiac surgeon who is Director of the Cardiovascular Institute at New York Presbyterian Hospital. At that fine institution, they have a second opinion service for people who were told to undergo heart surgery. He encourages patients to see him because he may find that you don’t need surgery after all.
Now that’s my kind of surgeon. You can find consultants like him by calling major centers or by looking at their web sites to inquire about referral services. Physician referral services run by local hospitals are often a waste of time because they give very little information about their doctors and they are not designed to identify the best physicians. They usually include every doctor on the staff, good, medium or not so medium. (Hopefully your local hospital has no bad doctors on the staff, but that does sometimes happen.)