Doubting your doc: Should I get a second opinion?

Susan Boerchers

Receiving a serious diagnosis is bad enough. But wondering whether your doctor knows what he or she is talking about can be even more unsettling. In such cases, it might be wise to seek a second opinion. And, fortunately, health insurance often will pay for a second opinion.

Question and answer

Before seeking a second opinion, be sure you understand what your doctor is telling you. Communication is critical between doctors and patients, and patients should be sure they understand the situation before deciding how to proceed.

One place to go for second-opinion referrals is the doctor who gave you a “first opinion.”

“First and foremost, ask questions,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group for health insurers.

• Do I understand my diagnosis?

• Am I comfortable with the treatment options proposed by my doctor?

• Can I handle the side effects associated with this treatment?

• Am I confident in my doctor?

After satisfying the first question, a second opinion may be warranted, depending on the answers to the subsequent questions.

“I encourage my patients to get a second opinion,” says Dr. Michael Sabel, associate professor of surgery at the University of Michigan. “I would not proceed with treatment if a patient is not completely comfortable with the procedure.”

Sabel led a study in 2006 for the university’s Comprehensive Cancer Center that showed that 52 percent of breast cancer patients who sought a second opinion from a multidisciplinary tumor board had one or more changes in their recommendations for surgery. For complex diseases like breast cancer, it’s reasonable to seek a second opinion.

Important factors to question include:

• How common is the disease?

• What is the experience of the doctor in treating the specific disease?

• What is the experience of the facility where treatment will take place?

• Which treatment options are available?

• What side effects will be encountered and how will they be dealt with?

• Are there alternative treatment options available?

Alternative therapies

Some patients may leave the beaten path altogether when seeking second opinions, opting to consult a homeopathic doctor or other alternative medicine practitioner. Alternative treatments, like acupuncture or a special diet, may complement the conventional therapy or help you tolerate any treatment side effects.

“I have not seen a patient yet whose quality of life was not improved by supportive ‘alternative’ therapies, and I have seen many whose cancers either totally remitted or stabilized, and no toxicity,” says Dr. Robert Rowen, author of the Second Opinion newsletter.

Preserving the relationship

Patients need not worry about harming their relationships with their doctors by seeking a second opinion.

“Any physician not comfortable with a patient seeking a second opinion may not be providing the best care or acting in the best interest of the patient in the first place,” says Dr. Jean-Luc Neptune, chief operating officer and co-founder of ExpertConsensus, which offers second opinions and other personalized health services. “This may be a sign that the patient should indeed seek a second opinion.”

Both Sabel and Neptune suggest the best place to start when seeking a second opinion is by asking your doctor for referrals. “I give my patients recommendations all the time,” Sabel says.

Another place to turn is to a teaching hospital or any concentration of experts in a certain field, such as cancer. Reputable health care websites are other good places to research a diagnosis or medical recommendations.

When a conflict of medical opinions occurs, it is the role of the primary care physician to help the patient make sense of the differing opinions and treatment options available.

“In the old days, a physician had more time to sit down with a patient and evaluate options, but physicians don’t have the time to do so in today’s practice environment,” Neptune says. “However, given the complexity of disease, as well as treatments, people need help sorting through their options.”

A multidisciplinary board — bringing together medical specialists from several disciplines, particularly in cancer cases — or a collaborative effort like ExpertConsensus can help resolve conflicting advice. ExpertConsensus takes a panel approach to treatment, providing as many as four “thought leaders” and research experts on an individual case.

Insurance and second opinions

In most cases, health insurance will pay for a second opinion. When the doctor and patient agree that someone else should look at the specific situation, the recommended physician often is within the patient’s existing health care network. Some health insurance plans even encourage getting a second opinion before authorizing a procedure.

Most ExpertConsensus clients, however, pay out of pocket for their second opinions. Rarely are third opinions recommended. For cases when the disease is so complex that numerous opinions are necessary, patients may be best served by a collaborative health care approach, such as that offered by a multidisciplinary board.