Second Opinions

Getting the Best Care - August 1, 2012

My husband was treated by two different oncologists during the course of his illness. Both of these physicians have years of experience and are highly respected in the field. We had absolute faith in both of them. When we found out that my husband's cancer had reached stage four, we had some important decisions to make regarding the next steps for his treatment, so we met with both oncologists separately to get their recommendations. Those meetings surprised us, because each doctor had a drastically different recommendation for the next steps of treatment; as that treatment went on, the doctors often contradicted each other over what was advisable or even possible for his care.

When we met with Dr. B, he insisted that my husband must have improved nutrition if he were to continue with chemotherapy. He recommended having a j-tube inserted into my husband's intestine so he could get all of his nutrition that way. He told us that if the surgeon felt my husband wasn't strong enough for a j-tube, there was no point in continuing with chemotherapy. Later that day, while Dr. D was reviewing my husband's chart, he wondered aloud why a surgical consultation had been ordered. I explained that Dr. B said a j-tube was absolutely necessary prior to considering more chemotherapy. Dr. D told us that my husband could get all his nutrition through TPN, which is delivered though an IV. Dr. D also said we didn't need to be concerned about my husband's nutrition at this point because he was still able to eat and his weight was stable.

It was hard to know which expert to believe. At this point in my husband's treatment, with his cancer at stage four and the situation more serious than ever before, he and I were both confused and emotional, and the conflicting advice of the two oncologists only made it worse.

At one point I spoke to a nurse about the contradictory advice we were getting from Dr. B and Dr. D. This nurse happened to work for them both on a part time basis and knew them both very well. I took her aside and privately asked her why they were giving such different advice and whose advice we should follow. She told me that they were both right and they were both wrong, that medicine is far more of an art than a science. She said we should listen to them both, and that we should also ask them specifically why they thought their recommendation was better and why the other doctor's recommendation wouldn't work. Then, after considering both doctors' advice, we should follow our hearts.

So what do you do when the experts are giving you advice on treatment options? First and foremost, and especially when you are starting treatment or are facing a major change in the patient's condition, GET A SECOND OPINION. I can't emphasize this enough. In my experience, doctors are not offended when you ask for a second opinion. Their staff is usually really great about quickly sending patient records to another doctor to review. If not—if a doctor seems to be upset or offended by your desire for a second opinion—I would be very concerned, and I would feel it was even more vital for someone else to review the case.

When seeking out a physician to give a second opinion, you have several options. You can simply ask the first doctor for recommendations. You can contact a teaching hospital or research facility to review your patient's case. Researchers generally tend to be more specialized, and may provide a different perspective than a generalist. If time is of the essence, though, you may want to consider that often it can take weeks or even months to get an appointment at a large teaching hospital.

Another option for finding a second opinion is to seek out a physician with a slightly different philosophy of care. Some physicians employ a traditional approach using only western medicine, while others incorporate complimentary medicines from eastern and other traditions. The opinion of a physician with a different approach to care may provide you invaluable insights.

Usually insurance providers will cover the cost of a second opinion. Depending on your plan you may have to select from within your network, and there may be other limitations. If there is no coverage for a second opinion, cancer patients can contact www.thesecondopinion.org for a free review of your case. For non-cancer patients or those outside the SF Bay area, you may also be able to consult a community hospital or clinic for a free second opinion.

The second opinion you receive may just confirm everything that was recommended by the first physician. This can be a great comfort and confidence builder. The second opinion may send you on a completely different course of treatment. The most important thing I learned in the process of managing my husband's care was that there is never one right course, never just one path. Every expert's advice is really only an opinion. Keep asking questions and seeking out new recommendations, and always choose the path that feels best for your particular situation.