The Second Opinion: Trust but Verify

 

Dear Readers,

Lots of health care coaches, me included, stress the importance of getting a second opinion at every significant medical crossroads. But seven out of ten of us don’t do it, according to a recent survey. Everybody knows the basic idea of a second opinion, but we hesitate.  Sometimes it even feels wrong. What gives with that? And what does this tension tell us about the times when our instincts can defeat us?

In this newsletter, we’ll answer those questions, and explain why the second opinion should always be your first choice. Read on for more.

Why We Hesitate to Get a Second Opinion 

I can prove to you logically that getting a second opinion is one of the key steps to getting better health care.  In fact, I made it a whole chapter in my book, The Life You Save.
So why do we not follow through?  There’s a simple but pretty profound reason: Trust is an essential part of health care. We form a trusting bond with the doctors and nurses who lay their hands on us.  If we lack that trusting bond, we have disabled an important part of the healing process, the part that feels secure and safe and optimistic about how things will turn out.
So it’s natural to feel that if we seek a second opinion, we fret that we are betraying the trust that we need to have in our caregivers.  That makes us feel awkward at best when we think about getting a second opinion.  And we worry that we will irritate or insult the doctor who gave us the first round of advice, and that might mess with the curative mojo between that doctor and us.
There are powerful reasons in evolutionary biology why we abandon rationality and look for an authority figure when we’re under major stress, which happens with any new diagnosis of a serious disease. So be aware of how powerful this instinct can be.
Yet there is a simple answer to the dilemma about whether we should trust the first doctor who gives us a piece of bad news:
Trust — but verify.
When we get another opinion to verify what doctor No. 1 told us, one of two things happens: We learn the first doctor was right, and that helps cement the trusting bond with that doctor, OR we learn that we may want to go in a different direction, in which case the trusting bond with that doctor loses importance.  Either way, we’re better off.
More on why we need second opinions and how they benefit our health in the next piece below.

Seven Ways Second Opinions Improve Our Health Care 

 

Here is why second opinions are so important when we face any major decision point in health care:
1. The first opinion can be plain wrong. This is often the case with surgical biopsies. It’s not that the first reading was incompetent (but that happens too). It’s that there are different levels of expertise, and when you seek a second opinion, you can often obtain one from someone who specializes in whatever condition you have under evaluation.

 

2. Sometimes neither opinion is “right” or “wrong,” but getting a second or third opinion helps you realize that your own goals and values are the most important thing. Especially in an end-of-life situation, quality of life and longer life can be at odds. That helps you decide how aggressively to pursue a course of action.

 

3. The process of getting a second opinion helps open up the channels of communication and education. As noted in the Harvard Health Letter, “A second opinion can be helpful just because another doctor may explain things in a way that’s more understandable to you.”

 

4. The second opinion helps you trade up to a higher level of expertise for whatever treatment might be on your horizon.  Even if doctor No. 1 was right about what you need, that doesn’t mean he or she should do the procedure.  You might learn at a second opinion that someone else has a lot more experience and a better track record of good outcomes.

 

5. Getting multiple opinions is a good litmus test for the doctor opinionators. Good doctors welcome the chance to see what other doctors have to say about their proposed treatment. Dr. Gregory Abel, a blood cancer specialist at Harvard-affiliated Dana-Farber Cancer Institute, said, “If you have a doctor who would be offended by a second opinion, he or she is probably not the right doctor for you.” I agree 100%.

 

6. Second opinions can save you money by advising against unneeded tests, procedures or drugs. Remember that our health care system is rife with over treatment.

 

7. Second opinions can save your life.  Whether the second opinion steers you away from a reassuring but wrong “nothing’s the matter” opinion, or steers you in the opposite direction away from aggressive care that is unlikely to help you, your health will be better off for it.

Making the Second Opinion More Productive

Some tips to make the process work well for you:

  • Ask your doctor, nurses and family and friends for referrals. Many hospitals also offer second-opinion services.
  • Check with your health insurance plan to see if the second opinion is covered. It should be.
  • Prepare for the consultation. The second doctor will want to see your lab work, imaging studies and possibly other pieces of your medical record before offering an opinion. Before your appointment, contact the doctor’s office to find out what you should bring or have sent.
  • Discuss what matters to you.  Take a list of questions.  One study of breast cancer patients found that they were more likely than providers to focus on possible side effects from chemotherapy and hormone therapy.
  • At the appointment, take notes or bring someone with you to do it.  See our newsletter on “Helping Your Doctor Make the Right Diagnosis,” for more on this, including the importance of bringing an ally with you to the meeting.
  • Consider asking the second doctor to give his or her advice before knowing what the first doctor’s advice was.  (Some second opinionators tend to adjust their thoughts to conform with what the first doctor said, which defeats the whole process.) But don’t conceal what the first doctor said if doctor No. 2 really wants to know that first.  The point of the process is open and honest communication.
  • Getting a second opinion on a surgical biopsy is easy.  I explain more in the patient safety tips on my website; click here.

 

To your continued health!

Sincerely,
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Patrick Malone
Patrick Malone & Associates