Second opinion not your first thought

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Second opinion not your first thought

Cindy Thomsen was 18 when her doctor told her she would die in three months. He said there was nothing he could do.

Thomsen, 60, grew up in Lompoc and says the family’s regular OB-GYN at the time “didn’t have the best bedside manner.” When he discovered the tumor on one of her ovaries, he first didn’t explain to her parents it was malignant. Then, he decided to call her to deliver the bad news while she was working at a pizza place.

“He told me over the phone, as I’m taking orders, that I’m going to die in three months,” recalls Thomsen, a Santee resident. As soon as she talked to her parents, they were done with him.

“We’re going to get another opinion,” they said.

They took her to Los Angeles, where she received second and third medical opinions, had surgery to remove the ovary and then chemotherapy over 18 months. Forty-two years later, the cancer has never returned and she’s grateful her parents sought expert advice.

Thomsen’s experience was extreme, but, as she says, it points out the importance for patients to seek other points of view when diagnosed with life-threatening illnesses or surgeries and serious treatments.

Yet seeking a second opinion isn’t a common inclination for most Americans. Seventy percent polled by Gallup in 2010 said they have confidence in their doctor and haven’t or wouldn’t seek a second opinion.

Even the 30 percent who would sounds too high to Dr. Mark Urman, a former medical director of the Heart Center at the Cedars-Sinai Heart Institute in Los Angeles and a clinical professor of medicine at UCLA’s David Geffen School of Medicine.

“It’s probably closer to, some would say, 10 to 20 percent, if even that,” he says. “Most patients don’t end up getting a second opinion. I’m not saying everybody should. It depends on what you’re talking about.”

Urman encourages patients to seek other opinions when circumstances are serious, such as when:

Patients receive a first-time diagnosis of a life-threatening situation or disease;

They have serious symptoms but are told, “everything is fine”;

They face a major surgery or treatment procedure.

In those circumstances, says Urman, he always counsels even his own patients to obtain another medical opinion, especially if they “have any concerns or doubts.” Urman says it’s paramount to get things right even when he makes the initial diagnosis.

“There have been times I see somebody and I look at them and I look at all their tests and their results and I’ll say, ‘I’m pretty sure this is what it is, but I’d even like you to see somebody else, to be smart, to see if they concur,’” he says.

Getting more information

The American Medical Association’s Code of Medical Ethics declares it is a patient’s prerogative to seek a second opinion, and a recent study in the International Journal of Public Health Policy and Health Services Research points to why second opinions are necessary.

That study, published in April of this year, found in an examination of nearly 300 patients, only 12 percent of first diagnoses were the same as second diagnoses. In 66 percent of cases, second diagnoses largely concurred with first opinions but were better defined and offered more information and options. In 21 percent of cases, final diagnoses “were distinctly different.”

“Knowing that more than one out of every five referral patients may be completely (and) incorrectly diagnosed is troubling,” wrote one of the study’s authors.

In 2015, the National Academies of Sciences, Engineering and Medicine published a report that found most patients will receive an incorrect or late diagnosis at least once in their lives, “sometimes with devastating consequences.” Part of the report’s conclusion was that “improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.”

Getting a second opinion can help patients ensure they get as much information as possible to avoid such problems.

Yet most patients — as the Gallup poll noted — trust their doctors. Mary Murray, a longtime emergency-room nurse, says it doesn’t occur to most of the patients she’s encountered to seek a second opinion.

Yet Murray, who became a patient advocate three years ago when she founded San Diego Patient Advocacy, says it became clear to her during her nursing career that patients need more information to make better choices. She says getting a second opinion:

Wraps up all of the pertinent facts again, often in new language, to help make the situation more clear;

Can point out a completely wrong first diagnosis. (In such a case, a third opinion would be sought to more likely ensure the correct diagnosis.);

Provides a patient more choices (such as therapy or medication over surgery).

Also, she says, second opinions can help patients avoid medical biases.

“If you go to the guy who does chemotherapy, obviously he has a bias for that,” she says. “If you go to the surgeon, their motto is ‘To cut is to cure.’ … So you always have to be aware of the bias that exists no matter who you see.”

Murray suggests to her clients that simply getting all their care under one medical umbrella — the same hospital or care network, for instance — will allow all physicians they visit to see their entire profile (history, medications, surgeries, issues) so they can make better judgments. Just doing that, she says, helps doctors make better decisions.

Sometimes, too, a second opinion can provide a patient with an alternative to surgery, which can be valuable. Spending less time in a hospital can be positive, because of the rates of healthcare-associated infections.

“You need to know if there’s another option besides surgery, for sure,” says Murray. “Because any time you’re doing something invasive, you’re putting your client at risk. Inherently, surgery puts a patient at risk, so you need to know whether that really is the option or the only option or what else is available that could be as curative.”

No hurt feelings

Typically, medical insurance covers second opinions, particularly in cases with serious issues. Some even require them in the case of a costly procedure.

Now, second opinions can be sought not only through traditional channels but also via online sources, such as the Cleveland Clinic, Massachusetts General Hospital, UC San Francisco Medical Center and a company called Second Opinion Expert.

Urman is vice president of physician relations and quality assurance for Second Opinion Expert, founded in 2014. The group has a network of doctors that can provide opinions in their specialty areas. He says it’s part of the growing state of “telemedicine” that can enable patients in rural areas or who can’t travel to get opinions from specialists at major medical facilities.

Urman says many patients are perfectly comfortable not seeking a second opinion, and he understands that. They may have a great relationship and history with a doctor or medical facility. But he says some patients he’s provided second opinions for did not want their doctor to know, because they were afraid of offending their physician.

“I’ll usually tell them, look, a doctor should not feel slighted, the doctor should not feel bad,” he says. “I certainly do not feel bad when patients get another opinion. … Nobody’s ego should get in the way. It’s about doing what’s best for the patient and what’s right for the patient.”


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