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Second Opinions


Web MD -- Two heads are better than one—or are they? What about three heads, or four, or a whole committee? When it comes to medical issues, especially complicated cases, many people seek or are advised to get another opinion.

Imagine this: a doctor tells you that you need surgery on your nose for a deviated septum. You are a bit puzzled since you really are not having a major problem with your nose, unless you have a cold. You don't want to have surgery for an incidental finding, but here is a well-trained, authoritative clinician making a firm recommendation. Some people will agree to be scheduled for surgery, some will want to think about it, and some will be highly skeptical and immediately seek a second opinion. They go to another ear, nose, and throat specialist who totally disagrees. Now what do you do?  Do you believe the second opinion just because it was the last opinion, or do you leave totally confused?

A serious combination is an unassertive, uninformed patient who happens to have excellent insurance.  I am often appalled by the number of people who have had surgery that I considered unnecessary or, at least, borderline questionable. Many patients are justifiably skeptical about an economically driven clinician. This is not to say that a surgeon in private practice is not a good surgeon, or that his/her opinion is incorrect. Perhaps as a primary care clinician – a non-surgeon – I am more conservative. My fixed salary is not dependent on the number of cases I take to the operating room. As long as I am "paying my keep", the bean counters in our non-profit medical group do not take notice.

Why do people seek second opinions?

1.       They did not like or disagreed with the first opinion, especially if it meant surgery.

2.       They want confirmation of their first opinion so they can make a more-informed decision.

3.       The clinician giving the first opinion had "no clue" as to what was going on.

4.       They did not care for the bedside manner, office staff, demeanor, etc. of the clinician giving the first opinion.

People want to get better and most are willing to spend good money, undergo surgical/anesthesia risks, and endure painful periods of recovery and rehabilitation to achieve a cure. If it takes a surgical procedure, then so be it.  If a surgical recommendation is not expected, however, the patient's blood pressure and pulse rate rises in an anxiety response. In this case, it's best to take some time to consider your options. After all, we avoid grocery shopping when we are hungry, and we should never be so hungry for a cure that we do not take the time to ponder a decision, or consider seeking a second opinion.

Doctor A recommends surgery. Patient freaks out (on the inside). Perhaps there is some more that can be done to avoid surgery? Some people will seek second (and third, and so forth) opinions from their non-medical friends. Some will hit the Internet chat rooms and consider opinions rendered by total strangers. Some will ask me in the comments. Since I have absolutely no way of delving into the complexities of their medical history, order or review diagnostic tests, or examine someone over the Internet, this is something that I could never do. Not only would rendering an official second opinion be against WebMD policy, it doesn't make medical sense to blindly go where no clinician should ever go.  I do not blame people for asking. They are doing their homework and that is good.

Some people go 180 degrees and seek non-traditional, alternative care. Maybe a chiropractor can cure my chronic sinusitis or adjust my deviated septum? Maybe I should take vitamins and other supplements? Should I try homeopathic remedies? Home remedies? Acupuncture?  Massage?  Faith healing?  There has got to be something else other than surgery!

Patients may seek second opinions hoping to confirm the diagnosis or treatment plan of the first clinician. Two of the same opinions tend to tilt a skeptical scale. As long as the second opinion is not a friend or colleague of the first clinician, a validation of the first opinion may be unbiased and true.  If you are seeking a second opinion from a clinician who absolutely hates the first clinician, you may end up getting a biased, opposing opinion.  Now, you have a quandary: two different opinions. Do you get a third, a tie-breaker?

Doctors are like cooks. They all cook a little differently. One surgeon may love to head to the operating room, while another may be more conservative and only recommend surgery for the worst cases—those that are unlikely to improve without surgery.  Just because Doctor A recommends surgery and Doctor B disagrees does not necessarily mean one was wrong. They are simply offering different opinions. Of course, this does not help a desperate and confused patient one iota.

Not all medical providers are equal. Some will be tenacious and turn over every diagnostic stone until they get a definitive answer and a definitive solution. Some, unfortunately, will simply throw in the towel on the first visit. They may not take the time to explain their rationale to the patient, leaving them even more confused, more frustrated, and, perhaps, even angry that they wasted their time (and money).  People expect and deserve to have a thorough examination and a thorough explanation, but sadly, many leave an appointment unsatisfied.  I have heard (and experienced first-hand) about clinicians that will spend two minutes with a patient, look in the ear for a second, and simply say, "I don't know. I guess you will have to live with it."

Personally, I saw one particular urologist two times and was never once examined. I had an ER visit where the ER physician apparently forgot to examine me either. What in the world do they write in their medical records? Do they make things up (it happens), or do they simply not make notes? In both of these personal examples, they didn't bother to write anything.

Medicine is unbelievably complex, as are the patients we see. Clinicians are merely paid consultants and not your boss. A medical provider who may be highly trained in the technical/surgical skills of medicine may have missed the classes on patient interaction. A patient should not have to choose between an arrogant, impersonal, highly skilled surgeon and the nice guy with borderline skills, but many choose the nice guy. He was good salesman.

Getting differing opinions is always a dilemma. Some insurances will not pay for a third opinion, and even if your insurance does, what if you get yet another differing opinion? My advice is simple: Select one. Select the opinion of the medical provider that took the time and effort to review your medical history, performed the best medical examination, and the one that respectfully responded to your questions.

Second opinions are often needed and they may be confusing. In the end you, the patient, will have to make an important decision. Choose your path wisely.

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