Tuesday, November 27, 2007

Second Opinions - Blinded and Two Different Options

What is a "blind second opinion"? What are the advantages and disadvantages?
A “blind second opinion” is seeing another doctor, but not providing him any of the other doctor’s notes, lab results, x-ray results, or biopsy results. Advocates feel that by not giving the second opinion doctor any information that it makes him more objective and less likely to be biased by the first doctor’s work-up and assessment. The problem is that since the second doctor is essentially starting from scratch, the patient may need to undergo repeat testing which may be costly. Also, if the second opinion differs from the first, it won’t be clear to the patient why the doctors disagreed with each other since neither one has access to the other’s information.

For a second opinion to be worthwhile, patients should provide the doctor all of the previous doctor notes and results so that he understands what has already been done. What makes it a great second opinion is having the doctor now step back, ask and examine the patient as if it was the first time seeing him, ignore the medical record, reach his own conclusion and then see how his opinion either supports or refutes the diagnosis and plans of the first doctor. If you see a doctor who keeps pushing you to talk about your symptoms and treatments and not what other doctors have said or what the tests showed then you’ve found yourself with a doctor who will give a great second opinion.

If a patient gets two opinions on a condition and they vary greatly, how does one make a decision?
If there is this situation then it means that for that particular condition there is not a general consensus or agreement on what the best treatment is. In this case, there are a few of options. One is to get a third opinion and see if it provides a middle ground between the first two cases. The other option is to get a third opinion, but have it with a guru or nationally renowned expert on the condition. It is possible that with these options that there might be three very different opinions. In this case, the best decision is to find the doctor who suggested a treatment plan the person was most comfortable with. With three opinions for the same condition, it is even more clear that there is no agreement and therefore a person can’t be truly faulted for making a less than ideal choice as three doctors couldn’t agree. What is most important at that point is that the patient makes a choice he is comfortable with.

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