While watching my daughter fight for the soccer ball, I struck up a conversation with the father of another young player. I knew that his wife, an active woman in her forties, was being treated for breast cancer, but I learned that she was now battling an aggressive recurrence, as her malignancy had spread (metastasized) to her bones. The local oncologist who had treated her initial disease twenty months earlier was now somewhat desperately administering “a variety of chemotherapy drugs” to try and hold her cancer at bay.
We’ve made monumental strides in the early detection and treatment of breast cancer, in large part due to the highly successful public awareness campaign. Today, more than 89 percent of women are alive five years after first hearing, “You have breast cancer.”
Clearly the wife of this soccer dad was not suffering from the typical breast cancer routinely treated in our small community. Thus, I asked him what advice they had received from their second opinion. After all, a leading cancer institution was only two hours down the road from where our kids were currently chasing the soccer ball.
“We didn’t get a second opinion,” he said quietly. “We didn’t want to upset or offend our doctor.”
Now, you may be shaking your head in disbelief. After all, it isn’t her oncologist whose life is on the line here. Yet the need to avoid “upsetting or offending” a physician is a remarkably common explanation for failing to seek confirming or differing medical advice via a second opinion. Most of us were raised not to challenge our doctors. And cultural norms and upbringing are strong forces. So even in the face of a rare or worsening medical condition, many folks are still too uncomfortable potentially “upsetting or offending” their physician to make sure that they are receiving the best care.
In Own Your Cancer: A Take-Charge Guide for the Recently Diagnosed and Those Who Love Them, I emphasize that good physician partners are neither upset nor offended when you seek a second opinion. In fact, if your doctor does get upset or offended, find a new doctor. Good physician partners recognize that health care is all about you, not us.
Now let’s be clear: Not everyone needs a second opinion. The treatment of most medical conditions, while not always black-and-white, has been defined, refined, and proven over decades. Thus in the vast majority of cases, there is no question about the best diagnosis or treatment (the only question is whether you have the right physician partner, a topic for future discussion).
So, when should you seek a second opinion? In response, I offer these general guidelines:
- If you have an advanced, life-threatening disease (such as metastatic cancer), a second opinion will hopefully confirm your current approach as best for controlling or even beating your illness.
- If you have a serious condition (such as heart failure) that regularly worsens, a second opinion may lead to better control of your symptoms and reduced E.R. and hospital visits.
- If you have a condition which is uncommon or rare, a second opinion may make you more comfortable with your current doctor’s approach.
- If your doctor has had little or no experience caring for people with your condition (and you should ask), seek a second opinion.
- If you or your loved ones simply feel that the recommended care is not right for you or that your current treatment is failing, seek a second opinion.
Remember: Second opinions seek to confirm that the original recommended approach is the best specifically for you. If the second opinion does differ significantly from the initial recommendation, you need to make a decision. If the differing second opinion sounds more appropriate, then go that route (which may mean that the second opinion physician will become your treating physician). And, yes, occasionally a third opinion is actually helpful in selecting between the first two (hopefully you won’t get yet another differing recommendation!).
I am always baffled when patients ask their current doctor to recommend a second opinion doctor. If I bring my car in for an oil change, and the mechanic tells me that I need a complete engine rebuild, I don’t ask his mechanic partner what he thinks. How likely is it that my partner’s second opinion will substantially differ from mine? My partner and I are, well, partners. My partner wouldn’t intentionally risk your health to support me, but we are surgical and business colleagues with shared professional and, likely, social and financial interests. It’s just human nature. You must seek a second opinion from a physician who is not in a professional or personal relationship with your doctor. Your second-opinion physician’s only goal (conscious or subconscious) must be to recommend what’s best for you.
The second general principle is that your second opinion physician’s training and experience in the care of patients with your specific medical condition should be the same or better than that of your physician. For example, if your diabetes is worsening under the care of your general practitioner, seek a second opinion from another general practitioner or, better yet, an endocrinologist (a general practitioner with additional training in diabetes). In a nutshell, don’t take a step down in physician training or experience.
Finally, there is the reality of insurance. If there is no appropriate second opinion physician within your network, or if your insurer does not cover second opinions, make some noise. Pick up the phone and be polite but unrelenting. It doesn’t always work, but sometimes it does. If still you lack coverage, then you must decide whether you can afford not to pay for what may be life-critical information.
So there it is…my opinion on second opinions.
Own Your Health!
Peter Edelstein, M.D., is also the author of Own Your Cancer.