“A second opinion is when a doctor other than your regular doctor gives you his or her view about your health problem and how to treat it.” Definition on Medicare.gov
In 2011, Susan [name changed to protect her identity] found a lump in her right breast. She went to one of the two nearby university medical centers. At facility A, the surgeon told her that her cancer required a mastectomy with simultaneous node biopsy. If the sentinel node had cancer, the surgeon would immediately remove nodes in her underarm and upper chest. Then she would undergo chemotherapy and radiation therapy.
Susan went to facility B for a second opinion. Instead of an immediate mastectomy, facility B’s surgeon said treatment involved, first, a biopsy of sentinel nodes. After determining if the cancer had spread, Susan would undergo chemotherapy before surgery. If there was shrinkage of the lump, there might be a surgical option other than mastectomy. Another benefit of chemotherapy first was that the team could learn how her tumor responded to the chemotherapy. This information would give an indication of the likelihood of recurrence and impact treatment decisions about radiation.
Two medical centers with two very different treatment strategies to deal with the same breast cancer. Although surprising, this is not uncommon.
Recent Research on Second Opinions
In a study of a patient-initiated second opinion program (free to employee-beneficiaries) 6,791 second opinions occurring over a 2-year period (January 1, 2011 to December 31, 2012), the majority of second opinions confirmed both diagnosis and treatment. However, in almost 15% of cases, the second opinions changed the diagnosis. In addition, second opinions modified almost 37% of the first recommended treatments. In almost 11% of the cases, second opinions altered both the diagnosis and the treatment.
Moreover, the clinical impact was described as moderate or major in 20.9% of the cases where the second opinion changed the diagnosis. A moderate or major clinical impact occurred in 31% of the cases where the second assessment changed the treatment.
This study supports the value of second opinions.
Now, many employers are contracting with second opinion services. Some insurance companies require second opinions for surgery.
Recommendations For Getting a Second Opinion
When should you think about getting a second opinion?
1) if you have received treatment but your symptoms continue.
2) if you are diagnosed with a rare disease
3) if the treatment that is suggested is invasive, lifelong or risky.
4) If you are diagnosed with cancer
Advocates encourage getting a second opinion from a physician who works in a different practice and at a different hospital.
It is not easy to ask for a second opinion. Second opinions give you peace of mind that you have done everything you can do to assure that you have the right diagnosis and/or treatment.
Remember, you are not being a difficult patient when you ask for a second opinion. You are being an empowered patient. It may surprise you to learn that most doctors expect and encourage second opinions. So, be up front with your physician about your desire to have a second opinion.
If you don’t get support for a second opinion, you may consider changing doctors.