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    A Powerhouse Patient Is an Informed Patient: Getting a Second Opinion by Julie Buyon

    By agebuzz Contributing Editor Julie Buyon


    Let me cut to the chase: Get a second opinion. And even a third if the first two providers disagree on your diagnosis and/or course of treatment.


    As an agebuzz reader, you are clearly someone who wants good information from a reliable source. And if you’re a reader of the Powerhouse Patient series, you understand the importance of doing research to make healthcare decisions that are right for you. Getting additional opinions from experts on your diagnosis or recommended medical treatment can be an important part of that research. You want to confirm the diagnosis, feel confident that you have explored all the appropriate treatment options, and that you are working with a care team with whom you are comfortable.


    Diagnoses are not always straightforward. Invasive tests, like a lung biopsy, may not always be the best way to get the needed information and may bring their own risks. Treatment approaches to a medical condition can and do vary across the country – even across town at different medical centers. Some clinicians may be more or less aggressive than others – you won’t know what is appropriate for you until you do this important part of your research. Medical research and innovative new treatments surface daily, and you want to explore any new therapies that might be available to you.  


    Most importantly, remember that very smart doctors can reasonably disagree on a diagnosis and a course of treatment. We expect our doctors to be superhuman, infallible, and all-knowing – but they’re not: they are people just like us.


    Many people don’t seek a second opinion for a variety of reasons, but I think the main obstacles are:


    -Fear of offending your current doctor and undermining the trust established in that relationship

    -Fear of delaying treatment


    -Not knowing how to go about getting a second opinion


    No, you will not offend your doctor by getting a second opinion


    Some people fear they will offend or hurt their doctor’s feelings if they tell him or her they’d like a second opinion. They may be concerned it implies they don’t trust their doctor and are afraid it will damage the patient/physician relationship and perhaps receive poorer care as a result.


    If your doctor makes you feel that way, get another doctor. A good doctor – and a good partner in your care – will understand your need to gather as much information as possible and should welcome the input of another clinician.  Remember, you are the one in charge of your body and your health, not your doctor.  You don’t need someone else’s permission or approval to gather the information you need about your condition and your treatment. 


    When should I seek a second opinion?


    Each of the three times I had to decide on a course of cancer treatment for myself, I met with at least two expert clinicians. But getting additional opinions is not just for people with cancer. Consider getting a second opinion when:


    -You have a serious diagnosis

    -Surgery is recommended

    -You are diagnosed with a rare condition

    -An invasive test or other procedure is recommended

    -You have more than one medical problem (ie: cardiac issues and a cancer diagnosis)

    -You need peace of mind – confidence that you are making the right choices 

    -You want to make sure you have explored all  treatment options

    -Your doctor is not a specialist in your illness

    -Your doctor offers you several treatment options

    -A treatment option has serious side effects

    -The recommended treatment isn’t covered by your insurance, has significant risks, or is experimental

    -You’re uncomfortable with your doctor – due to communication issues, such as not listening to what’s important to you


    I could go on, but the bottom line is that more information will help you feel more confident that you are making the best healthcare decisions for yourself.  


    How long can I safely wait to get a second opinion?


    You should get a second opinion as soon as possible so that your treatment will not be delayed to the extent that may be harmful. There are certainly instances where serious treatment decisions must be made right away, but usually, there is a reasonable amount of time for you to meet with other clinicians and consider your options before committing to a course of treatment.  Of course, ask your physician how long you can safely wait before making a decision.


    Will I have to pay for a second opinion myself?


    Medicare will pay for a second opinion appointment, but if you have other insurance it’s a good idea to check what your policy covers – it may even require a second opinion for a particular procedure or it may mandate that the conferring physician be part of your health plan.


    How do I find a doctor for a second opinion?


    Contact a specialist who will be more knowledgeable about your condition. Get as specific as possible: if cancer is suspected, find an oncologist who specializes in that type of cancer, rather than an oncologist who treats a wide variety of cancers.  


    Here are some ways to find an appropriate specialist:


    -Ask your primary care physician or the physician who diagnosed the condition for a referral to a specialist. Ask family and friends in the medical community to help you in this search.

    -Contact a local institution specializing in your condition (such as a cancer center or cardiac surgery center). If one isn’t nearby, many renowned institutions offer second opinions remotely.

    -Connect with others with the same condition and ask them about their experience.  National and local support societies, organizations, and even activist groups can provide connections, feedback, and information about specialists.


    Once you have selected the specialist, ask what records will be needed – usually, it will be copies of imaging studies (x rays, MRIs, PET scans, et al) and reports (biopsy, pathology, surgical et al), as well as records regarding your other current medical conditions and medications. Have them sent directly to the specialist. As a Powerhouse Patient, you will already have copies of most of these things, but it will be more complete to have your current physician or hospital send the records to the specialist.


    What do I do if the opinions differ?


    If the second opinion concurs with the first, you should feel more confident in moving forward with the recommendations. You can choose to use your original doctor or the doctor from whom you received the second opinion if that is geographically practical.


    If the second opinion differs from the first in terms of diagnosis or treatment recommendations, you have more research to do, and a third opinion may be in order.  But first, discuss with each physician why they differ from the other doctor, and how each doctor arrived at his or her diagnosis or treatment plan. Ask about what research studies or clinical practice guidelines impact their recommendations, and if it is possible for the two doctors to confer about your case. 


    You may still need a third opinion to provide you with the information you need.


    Again, very smart doctors can reasonably disagree on a diagnosis and course of treatment.  Many factors may influence what a doctor recommends, including where they were trained, where they practice, if they are involved in research as well as clinical practice, and the depth of their experience in treating your condition.


    A woman I assisted last year was agonizing over deciding to get chemotherapy or not, as the practice guidelines for someone in her circumstances were not clear cut.  Her oncology team was recommending it but was unable to offer a convincing case as to why the benefits of chemo would outweigh the pain and risks of the treatment.  She connected with specialists 3,000 miles away, who were unambiguous in their recommendations and provided her with a clear understanding of their rationale. She was able to make decisions about her treatment in which she was fully confident. Getting a second opinion was critical for her to move forward.


    A Powerhouse Patient is an informed patient who partners in her care with her medical team.  You have a right to get all the information you need to make the medical decisions that are right for you!  And if your doctor doesn’t support you in that effort, I think it’s time to find one who does!


    Julie Buyon is a palliative care patient advocate. She has professional and personal expertise in assisting people with complex illnesses navigate the health care environment. Julie’s role is to help patients feel empowered, and her agebuzz posts are intended to make sure agebuzz readers have all the tools and info they need to advocate for themselves and their loved ones. Julie would love agebuzz readers to email her at [email protected] with any questions or problems encountered with the health care system, and she will do all she can to address those issues in upcoming blog posts. She also welcomes feedback regarding her advice or recommendations. Read all of Julie’s agebuzz posts here and get in touch with Julie now at [email protected].