ARE TWO MEDICAL OPINIONS BETTER THAN ONE?
Not long ago, two patients called to ask if they should seek a second opinion before undergoing surgery. The first had a large aortic aneurysm—a severe bulge in the body’s main blood vessel. A surgeon he consulted had recommended major surgery, despite the hazards of the operation and the pro-longed recovery to follow.
The second patient had nasal polyps—benign growths that can contribute to congestion in people with allergies. An ear-nose-and-throat doctor had proposed removing the polyps with a simple surgical procedure that could be done under local anesthesia, with little risk and little pain after surgery.
WHICH PATIENT MOST NEEDED A SECOND OPINION?
Oddly enough, the second patient would have benefited more from another opinion. Caught early on, an aortic aneurysm can often be handled by lowering blood pressure and monitoring the condition. But for a large aneurysm, there’s really no other choice but surgery. For nasal polyps, on the other hand, several nonsurgical options are worth considering.
I’LL SECOND THAT
A second opinion is even more important now than in the past. Under pressure to hold down costs, some doctors may suggest a less expensive course of therapy when another approach might be more appropriate. Or they may be motivated to boost profits with a more costly alternative. In some cases, doctors base their advice not on scientific evidence but on their own clinical experience or that of their close colleagues. Or their advice may even reflect their confidence in their ability to perform a procedure successfully. A second opinion is one of the best ways for a patient to be sure that none of those biases will bar the way to the best possible treatment.
Patients should always seek a second opinion on procedures about which experts often disagree. In addition to surgery for nasal polyps, some other common examples include cataract surgery or radial keratotomy; coronary bypass or angioplasty; ear tubes to relieve middle-ear pressure; hysterectomy; knee- or hip-replacement surgery; and surgery for a herniated vertebral disk.
Even when there are no therapeutic alternatives to sort out, a second opinion can be of value. It can offer a fresh perspective if there’s a vexing clinical problem. Or it can confirm a diagnosis or the wisdom of a course of treatment, and thus ease any doubts you—or your physician—may have.
When seeking another opinion, try not to go behind your physician’s back, since the second physician will usually want to review data obtained during the original workup, thus avoiding unnecessary duplication. If you sense reluctance or defensiveness on your doctor’s part, that’s all the more reason to get a second opinion.
HOW TO GET ONE
Your best guide to a qualified specialist is your primary-care physician. Ask for the names of at least two experts, preferably ones affiliated with a university medical center or a large, nonprofit community hospital. Of course, if your primary-care physician gave the initial opinion, you’ll need an unbiased source for a referral. That might come from a professional acquaintance—a doctor nurse, or social worker—who knows a specialist personally or by reputation. Or you can call a reputable medical center or hospital and ask the secretary in the department that handles your type of condition for the names of staff specialists.
A referral outside your community lends independence to a second opinion by overcoming any financial or personal ties between doctors. Since physicians within a single community sometimes share an unjustified preference for a particular procedure, an outside expert may help offset local bias.
People in managed-care health plans typically find it hard-er to go outside the community. Such plans usually cover a second opinion only from an affiliated physician. Still, it can be well worthwhile even if it means paying for some or all of the consultation yourself.
Don’t be surprised if the second opinion agrees with the first; that’s usually the case. But if opinions differ, don’t rush to a third source—you’re not taking a poll. Instead, ask the doctors to support their opinions. Probe for answers to these questions:
• Have clinical studies shown that the suggested therapy will be effective? (Don’t settle for anecdotal reports.)
• How will the therapy affect your quality of life if it succeeds? If it fails?
• What are the risks of the therapy?
• What are the alternatives?
• What will happen if you do nothing?
On rare occasions when the facts still aren’t clear—or the first two doctors interpret the same facts differendy—it’s time to consult a third physician. Ask that doctor to explain why the first two disagree and to help you reach your decision.
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