Don't Be Afraid to Seek Second or Even Third OpinionMany people feel uncomfortable about seeking second opinions, fearful that they are questioning the authority or expertise of their physicians. Some fear that they will receive worse care if they appear to be pushy or difficult. Gathering multiple opinions on your medical condition can be one of the most emotionally fraught decisions that a patient has to make. But patients should do so, because research confirms what most people already feel in their gut: Not all doctors are alike. Physicians vary in how they were trained, what they specialize in, and where they practice. A decade long Dartmouth project has documented significant differences in treatment between regions of the country. Major studies suggest that doctors deliver the best, evidence-backed care only half of the time. And it's a rare medical condition that responds to only one treatment or therapy. Seeking multiple sources of expert advice is one of the best ways for patients to gather information before proceeding with a treatment plan. Rather than being an end-around their doctors, it is more like assembling the best team possible to guide patients through some critical, potentially life-altering choices. In a Johns Hopkins study of 6,000 cancer patients, researchers found that one to two of every 100 patients who sought a second opinion after a tumor biopsy had received a wrong diagnosis. "Patients should recognize that a pathologist is a human capable of mistakes," said Dr. Jonathan Epstein, the Hopkins pathologist who led the study. "Evaluating tissue isn't a machine-like process where everything comes out 100 percent correct. So it's worth a patient's while to get a second review of the pathology, just as they'd get a second surgeon's opinion." Good doctors also encourage the practice. "If the patient and I disagree on what is the best plan of care, I strongly encourage them to seek a second opinion, because I want them to have the option of finding a doctor who may agree with what they want to do," said Dr. Jennifer Frank, medical director at the University of Wisconsin Health Fox Valley Family Medicine Clinic. Frank tries to "distinguish between treatment plans that are my preference or way of doing things and plans that really represent what I think almost all physicians would do." And she might try to "steer a patient away" from seeking a second opinion that falls far outside the mainstream of proven therapy - treating a metastatic cancer with vitamins, for instance. Soon after Magdalena Muchlinski went to her doctor for gastrointestinal upset, she was looking for a second opinion. "The first doctor just said I had IBS [irritable bowel syndrome]. Pumped me full of meds and called it a day," said the West Virginia professor. "I really felt like the diagnosis the first doctor gave was uninformed and a cop-out." The diagnosis also turned out to be incorrect. "Our healthcare system doesn't always allow doctors to be true detectives and solve medical mysteries," Muchlinski says. "So I always get second and third opinions when I have a serious medical issue." Patients should know second opinions "are a way of life," to most physicians, said Dr. Daniel Weisdorf, a University of Minnesota oncologist. "We question our own opinions constantly by talking to each other." So how should patients bring up the idea? Frank recommends talking about it in person and using "I" language to make it clear that it's a concern about the diagnosis, not the doctor. If your doctor seems reluctant to help, that should be "a huge red flag for a patient," she said.
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