Second Opinion Health Article

Definition

A second opinion is the process of seeking an evaluation by another doctor or surgeon to confirm the diagnosis and treatment plan of a primary physician, or to offer an alternative diagnosis and/or treatment approach.

Purpose

Getting a second surgical opinion can fill an important emotional need as well as establishing medical needs and treatment goals. When a second opinion confirms initial findings, it can provide reassurance and feelings of acceptance for the patient, and may reduce anxiety and uncertainty.

From a cost-effectiveness point of view, second opinions can save health insurance providers money by establishing the certainty of a clinical need (or lack of need) for surgery, particularly when the diagnosis is a life-threatening.

Patients with a diagnosis of cancer may also benefit from a second-opinion pathology review of their biopsy material. A John Hopkins study reported that 1.4% of patients scheduled for cancer-related surgery at their facility were found to have been misdiagnosed when their tissue samples were reevaluated by a second pathologist. Similarly, a study published in the Annals of Surgical Oncology in 2002 found that a pathological second opinion of breast cancers changed the initial diagnosis, prognosis, or treatment approach in 80% of the 340 study subjects.

Several clinical research studies, however, have found that patients often seek second opinions not necessarily because they doubt the diagnosis or recommendations of their first provider, but because they were dissatisfied with either the amount of information given to them or the style of communication of their doctor. A 2002 Northwestern University study found that only 46% of patients coming into a breast cancer treatment center for a second opinion had been offered a complete discussion of treatment options during their initial consultation.

Description

Doctors often have differing viewpoints as to how a particular medical problem should be managed, whether through surgery or less invasive treatment means. One surgeon may prefer to take a "watchful waiting" approach before recommending surgery, while another may believe in performing surgery as soon as possible to avoid later complications. In some cases, several surgical techniques may be viable options for a patient. Medicine is not as black-and-white as many patients are led to believe, and physicians are not infallible. For these reasons, and because surgery is a major procedure with associated risks that should not be taken lightly, second opinions are an important part of the process of informed consent and decision-making.

Although a physician may strive to be objective, personal views and subjective experiences can influence their treatment recommendations. In addition, both the education and experience of a doctor in a given medical area can also influence the advice they offer a patient. For these reasons, seeking a second opinion from another physician and/or surgeon can be invaluable in making a decision on a course of treatment.

Second opinions are most frequently sought in cases of elective (nonemergency) surgery when the patient has time to consider options and make a more informed choice about his or her course of treatment. While a second surgical opinion may be requested in some cases of emergency surgery, they are not as common, simply because of the logistical limitations involved with getting a qualified second opinion if a patient requires immediate care.

In some cases, a doctor or surgeon may encourage seeking a second opinion, particularly when the preferred course of treatment is not clear-cut or another surgeon with advanced training or expertise may provide more insights into surgical options.

Patients should remember that it is their right to seek a second opinion before committing to surgery or another treatment plan. Embarrassment or fear of disapproval from a primary care provider should not be a barrier to getting a second opinion. A competent physician will not consider the decision to seek a second opinion an insult to their ability or experience. Instead, they will consider the patient an informed individual who is proactive and responsible for their own health care.

Patient seeking a second-opinion consultation may ask the provider questions similar to those they asked their primary provider. Questions may include:

• Are there other options besides surgery?
• What are the risks and benefits of each treatment option?
• How might each possible treatment impact quality-of-life for the patient?
• What kind of success rate is associated with surgery and other potential therapies?
• How is the surgery performed?
• Is surgery a permanent, long-term, or temporary solution to the condition?
• What type of anesthesia will be used?
• If surgery is chosen by the patient, how soon must it be done?
• What type of aftercare and recovery time is required once the surgery is complete?
• How much pain is to be expected postoperatively, and how is it typically treated?
• What are the costs involved with surgery and other treatment options, including postoperative care?

Providing the second surgeon with appropriate background information is important, but so is refraining from detailed descriptions of what the first provider did or did not recommend before the consultation begins. Patients should allow the surgeon to draw objective conclusions based on the medical history and diagnostic data before them. If the second opinion differs from the first provider's opinion, and the patient feels comfortable doing so, he or she might then offer information on the first provider's recommendations to get further feedback and input for a final decision.