Monday, November 19, 2007

Second Opinions - When and Why

When is it a good idea to get a second opinion?

Second opinions should strongly be considered when there is a potentially life threatening medical condition, like cancer, when the proposed treatment options are intensive or demanding, like chemotherapy or major surgery, or when there is a chance for a very bad outcome or complication, i.e. brain surgery. By having a second opinion, particularly in these high stakes situations, patients and their families will have the opportunity to have a second set of eyes double check to see if the original diagnosis and treatment plan are reasonable as well as a chance to hear someone else explain the problem which may be more understandable and enlightening.

With any other big decision — purchasing a new car or deciding to get married, for example — people instinctively seek out multiple opinions. Others voice their unsolicited opinion. When making a decision which could mean the difference between life or death, patients should not be shy about getting a second opinion. Patients should also ask their primary care doctor about their thoughts and understanding of the treatment plan of the first doctor and the need for a second opinion.

Why are patients reluctant to get second opinions?
Patients may be afraid that their doctor won’t take care of them in the future because they are asking for a second opinion. They may not feel the need to get a second opinion since they are comfortable with their doctor. They may not be aware that getting a second opinion is a good idea. They don’t know how to ask for a second opinion.

Do philosophies and treatment options vary among hospitals and medical practices?
Philosophies about treatment options can vary greatly depending on where and who the physician trained with, the physician’s field of practice, when the physician did their training, and the physician’s personal belief. Often for the same medical problem, different doctors, even within the same specialty, will have different recommendations and treatments. This is often a result of who they trained with and their clinical experience. Practice styles and philosophies also differ from the East Coast and West Coast.

For the example of leg pain due to a pinched nerve, some back surgeons will recommend early surgical intervention, while others suggest non-operative conservative therapy. If a doctor trained at a program that advocated watchful waiting, then it is more likely his philosophy is to be conservative. If his mentor, however, always recommended surgery quickly, then it is likely his own belief is that operating is more beneficial. After one year, research has shown that patients do equally well with either option.

For patients to see what the varying philosophies are, they will need to seek out different hospitals and practices. Even within a group practice, the doctors may have different approaches for the same problem.

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