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I’ll Second That

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Photo by National Cancer Institute on Unsplash

An unexpected diagnosis, a nudge in the direction of a surgery that sounds scary, a sudden change in a child’s health, or just a lack of understanding of information your provider has explained may leave you wanting to get a second opinion about your health situation.

As medicine grows more complex seemingly by the day, and the stressors on the healthcare system from covid are not going away any time soon, many patients may choose not to seek a second opinion, even as telehealth options have improved and increased, theoretically making these additional consultations more accessible.

In a small community such as ours, where you’re likely to run into your provider in the produce section or at the gas pumps, patients may be even less inclined to ask for a second opinion, wondering about the possibility of offending the provider or giving the impression there’s a lack of trust.

Importance of a second opinion

21% of seekers of second opinions received an entirely different diagnosis.

However, studies show that getting a second opinion often improves patient care and outcomes significantly, and insurers are sometimes at least paying for, and in other cases insisting on additional consults in complex situations.

In fact, few providers would be offended by your desire for something that has become quite commonplace today, and establishing open communication with your provider, letting her know that your intentions are to gather more knowledge to support the best decision making for your health will remove any apprehension on your part about offending your neighborhood doc.

While a second opinion may be superfluous for common conditions that resolve readily, there are several situations in which a second opinion is advisable. One 2017 study showed that 21% of seekers of second opinions received an entirely different diagnosis and 66% learned of different treatment options through more refined diagnosis.

If the diagnosis is cancer, it is imperative that you trust your team of providers as you make decisions about the ever-widening array of treatment options. One 2018 study published in the Annals of Surgical Oncology found that a second look by a National Cancer Institute-certified cancer center tumor board changed the diagnosis in 43% of the patients in the study.

If the diagnosis calls for surgery, it is important to be certain that all non-surgical options have been evaluated.

If you have a rare cancer it may be especially important to have your case looked at by a provider with more expertise. Often a different provider’s experience will be a better fit for you, and with cancer there is likely to be a long-term relationship with the provider, making it especially important to have complete trust as you begin that journey.

If the diagnosis calls for surgery, it is important to be certain that all non-surgical options have been evaluated. For the surgeon, the procedure may be something she’s done hundreds of times, maybe even a few times a day, but for the patient, surgery can be a traumatic ordeal, even if successful.

Most providers agree that surgery should be avoided if possible, so do not be shy about seeing another provider, especially those who specialize in helping their patients avoid surgery such as a “physiatrist” or Physical Medicine and Rehabilitation physician. Sometimes a diagnosis will not render a clear pathway, even for a surgeon, and talking to other types of providers or specialists can allow you to take in the information in a way that improves your comprehension and helps you decide which way to go.

A lot of data is showing that some orthopedic surgeries may not be necessary and that less aggressive care often results in better outcomes. Modern pain science is showing that the lack of correlation between pain levels and imaging makes it difficult to predict whether surgery will get a patient out of pain. A second or even third opinion may give you more options for care or may make the surgical options make more sense.

If the diagnosis is of your child, it pays to take extra care to be certain of all treatment options available. Kids can’t always describe their symptoms accurately, they may be afraid of going to the doctor, and there is most likely an emotional element for parents who go into mama bear mode at the thought of medical intervention. These factors can make diagnosis and treatment options more tricky for a provider to figure out. A good relationship with a pediatrician, including open communication, can be very helpful. If you are not satisfied with care from a general provider, seeing a pediatrician can be comforting or can make a step to the next level of specialist less scary for all involved.

How to ask for a second opinion

How to ask for a second opinion depends on your reason for seeking one as well as the initial diagnosis. The original provider may be able to refer you to a specialist, but if you are not comfortable with the original provider or their diagnosis you will want to make calls to different offices on your own, explaining your situation. Your insurer will be able to let you know whether a second opinion is covered in your plan, and may even be able to help you find an alternative provider. If a second opinion is not covered by your insurance, it is still a good idea to seek one, it may well pay off in the long run to take the additional expense.

Once you have settled on the second opinion provider, you will need to make sure all of your pertinent medical records are shared with the new office, a service for which there is sometimes a fee. Do not be shy about asking hard questions. While there is professional courtesy among providers and there can be a tendency to not contradict the initial diagnosis or treatment plan, the questions you ask can help direct the conversation away from critiquing a colleague and toward topics that expand knowledge and comprehension. Most providers who give second opinions want the same things the patient does: thorough understanding that leads to confident decision making and the best possible outcome for the patient.

Questions to ask include:

  • How much experience do you have with this procedure/treatment/diagnosis?
  • What alternatives are you aware of?
  • What complications can be expected?
  • How easy is it to reach you/how do you communicate with patients?

Be prepared to hear exactly what your first provider told you, and be open to any new information you receive. If things are still not clear, it is not unheard of to ask for yet another referral.

Be confident in your treatment plan

Making medical decisions is never easy, and as covid has shown us, change is the only constant. Studies have shown repeatedly that confidence in your provider and your treatment plan both are huge factors in the success of treatment, so for the sake of your health, inform yourself as thoroughly as possible. Fortunately, the days of “just do what the doc says” are fading into the past, and the professional and personal understanding that we are all in this together will likely guide you to a greater understanding of and participation in your healthcare decisions.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.

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