In the complicated world of medicine, it can often be beneficial to seek the expertise of a second doctor that can confirm a diagnosis or treatment of a medical condition. In fact, a second opinion can refine your diagnosis, change the course of your treatment, or even save your life. Dr. Pamela Gallin, a pediatric ophthalmologist at the Children's Hospital of New York Presbyterian, shares advice on getting a second opinion in her book, "How to Survive Your Doctor's Care." Here's an excerpt:
Many people have the wrong idea about second opinions. There’s a sense that it’s a means of “checking up” on your doctor, and that if you really trusted your doctor you would simply do what he or she says. But this is not true.
A second opinion simply means consulting another doctor for a diagnosis and/or treatment recommendation for the same problem. As we’ve discussed, many medical decisions come down to a matter of judgment, and doctors may legitimately arrive at different conclusions about the same case. Another doctor looking at a situation may bring a new perspective to it. An elderly relative of mine went to her general surgeon complaining that her belly was oddly large. She was told that she had an unusually large hernia down the middle of her belly. A hernia means that the contents of some organ or area protrudes through an opening, allowing the contents to come through. You can think of it as a pillow that has a tear and the stuffing is coming out. Usually they are “femoral” (in the groin area, typically a man’s scrotum), or “inguinal” (at the fold between the lower abdomen and the leg).
The surgeon informed her that this would require surgery to repair. As I’ve become something of the family clearinghouse for medical crises, she called me and told me about it. She was fully prepared to have surgery, but she wanted me to know. I said, “I don’t know what you’ve got,” and suggested that she get a second opinion before choosing to have surgery. Her situation seemed odd; she looked seven months pregnant, and it seemed peculiar to have a hernia in that area. I am not a general surgeon, but I did know of someone who could give her some answers. I gave her the names of two general surgeons, one at St. Lukes-Roosevelt, a Columbia affiliate, and the other at Columbia-
Presbyterian. Second-Opinion Doctor #1, Dr. George Todd (who had been at Columbia-Presbyterian and was now chief of surgery at St. Lukes Roosevelt), disagreed with her original doctor, saying that an operation to treat it would be unnecessary surgery. Furthermore, he disagreed with the diagnosis. In this case, her abdominal muscles were lax and her belly bulged out. But there was not a tear in the sac or muscles, as there would be in a hernia. In Dr. Todd’s opinion, there wasn’t anything to fix.
She had trouble believing this, so I told her to go to Second-Opinion Doctor #2, Dr. John Chabot. Dr. Chabot agreed completely with Dr. Todd. There was no hernia, and no reason to do surgery. Now, instead of one doctor telling her to have the operation, she had two out of three telling her not to. The problem, it seemed, was merely cosmetic. And at her age — she was in her late seventies — surgery would have put her at risk for other problems.
The Importance of Second Opinions
We’ve seen the impact of second opinions in several instances from the last two chapters: Alan Smith, the man with the web of blood vessels behind his eye; and Sarah, the young girl with the ovarian cyst, to name just two. If they had not sought out additional viewpoints, they would not have enjoyed the same fortunate outcomes.
Alan Smith would have been on steroids, and the treatment that saved his sight would have been delayed — perhaps at the cost of irreparable damage. Sarah would have been on a harsh chemotherapy regimen — perhaps unnecessarily. As a patient, it is in your interest to gather opinions from different physicians. In determining the most appropriate diagnosis and the most effective treatment, you — and any doctor treating you — need a broad base of information to draw from.
Confirmation or Differing Opinion
If, as often happens, the second physician ends up confirming what the first doctor says, this is far from a waste of time. Getting verification for one doctor’s opinion is important. When you accept a doctor’s assessment and recommendations, you are betting the farm that his or her pronouncement on your case is correct.
This assessment affects all subsequent treatment. So if having two different opinions is helpful, in that it gives you a choice or suggests where you might need more information, having two agreeing opinions is superb; you can now proceed to treatment with greater confidence.
Another common myth about second opinions is that, in seeking one, you will somehow offend your doctor. You can safely drop that idea. If your doctor takes umbrage at your seeking a second opinion, I would question that doctor’s judgment. No doctor should be more invested in being right than in the patient’s welfare. Good doctors know their limitations. Responsible doctors appreciate the wisdom of medical collaboration. Far from being insulted, a fine doctor will welcome another voice, for in medicine two heads are often better than one. This is particularly true when the conclusion isn’t clear-cut and the doctor has already been weighing different possibilities.
A second opinion is not questioning the honor and dignity of your well-intentioned M.D. Its purpose is to reevaluate the puzzle pieces and make sure they are assembled in the correct way so as to reach the same diagnosis or a different one. If it is indeed a different one, you must figure out why. Everything follows the diagnosis.
You can have the greatest, most advanced treatment in the world, and it won’t work if you’re depending on the wrong diagnosis. Don’t let a feeling of loyalty to your doctor deter you from pursuing a second opinion. Remember: Your health is at stake. You are the consumer. Sy Syms, a legendary clothes salesman in the New York area, uses this mantra: “An educated consumer is my best customer.” Ditto for medical care. Getting a second opinion enhances your knowledge about your condition, which makes you be a better consumer. This is to everybody’s benefit.
In this day and age, second opinions often serve as a check against unnecessary surgery. There’s a cultural stereotype of the scalpel-happy surgeon who wants to build an addition or buy a yacht on the bounty from his operations. But this is not so. In deciding upon a treatment, the decision not to operate is more difficult to make than the decision to operate. This is not a matter of drumming up more business. Rather, it reflects a very real desire to help people. A high-level, ethical surgeon prizes his judgment, honor, and professionalism above all else, but it’s always easier to tell someone, “I’ll fix you.” It’s harder to say no.
Physicians can respectfully disagree about the need for surgery. As we’ve seen, someone else might look at the very same puzzle pieces and say, “No, I don’t think surgery is necessary.” I recently conducted a second opinion for a child whose doctor recommended surgery. My exam yielded numbers that did not point to surgery. The first doctor’s did. That did not mean that he is a lesser doctor or even that he was wrong. The child’s parents asked me, “What is the downside of not doing the surgery?” Nothing, I told them. We can hold off on surgery, and if the situation gets worse, they still have that option. Surgery may in fact be needed, but I didn’t see that at the time.
Similarly, the general surgeon who suggested that my relative have abdominal surgery wasn’t an incompetent doctor. He had a dissenting view about a troublesome, not very clear, symptom picture. He was trying to help her. In many situations in medicine there is no “right” answer, but you still have to make a judgment.
It’s not black and white, but shades of gray. Physicians may see the patterns differently and thus come to different conclusions. Why did the Constitution institute a bench of nine judges on the Supreme Court? It’s the same thing.
A Complete Reevaluation
Frequently, the second-opinion doctor will confirm the original doctor’s diagnosis or treatment plan. But in order to concur with a diagnosis, all the factors need to be checked over again. This isn’t a simple grant of approval, as in, “Does the next guy like my dress?” This is a matter of ensuring the right course of treatment.
To arrive at a conclusion, one needs a lot of puzzle pieces. You have to have those pieces and they must fit together.
Medical consumers need to understand that this is part of the process. The original conclusion is an assumption on the part of the first doctor. It is not a given, it is not written in stone. It is a working hypothesis, no more. You go to someone else to verify that same conclusion. It is not an extra thing.
The initial doctor may say, “This is what you have,” and send you to the person who treats that problem. But you need to know if indeed you have what the first doctor says you have. Verification is part of the medical care package.
The bottom line is this: Once you make a diagnosis, you commit yourself to a course of treatment. Once you start treatment, you don’t always know if you’re heading down the right road. If a treatment doesn’t work well, is it because the antibiotic isn’t effective or the wrong antibiotic was chosen? That’s why second opinions are so important.
Excerpted from “How to Survive Your Doctor's Care: Get the Right Diagnosis, the Right Treatment, and the Right Experts for You” by Dr. Pamela Gallin. Copyright © 2004 by Dr. Pamela Gallin. Published by Lifeline Press. All rights reserved. No part of this excerpt can be used without permission of the publisher.