“Please see this patient for an urgent second opinion,” the letter on my desk begged.
But when I read the referral, it became clear that the patient was not so much looking for a second opinion, but rather confirmation of one not have cancer. However, her diagnosis was clear – and curable. What she needed was good communication and a way forward.
The aftermath of a cancer diagnosis is so overwhelming that patients often find themselves adrift. The abundance of unnecessary advice – on everything from genetics and lifestyle to mood and nutrition – adds pressure, making it understandable when patients crave simplicity.
Some patients walk away from a diagnosis and prefer to ignore it, while others are reluctant to seek a second opinion for fear of alienating their specialist. But many more people aren’t sure if or how to ask important questions to gain confidence in their care. In an era of remarkable medical advances, a second opinion can play an important role in guiding choices, shaping the future and, most importantly, saving time poisoning.
A doctor with cancer recently illustrated the discrepancy between the way she and her oncologists viewed her treatment. The “universal” medical attitude that she was “getting this treatment right,” she lamented, minimized her suffering from immense fatigue, nausea, explosive diarrhea, hair loss, joint and muscle discomfort, loss of salary, inability to drive due to brain fog and loss of mobility, to name a few. Her powerful words underlined the importance of listening to the patient as well as to the literature.
Given the resulting impact of cancer treatment on virtually every aspect of life, there are good reasons to seek a second opinion.
Doctors generally regard a second opinion as the assessment of a diagnosis or treatment plan proposed by a fellow specialist. In fact, oncologists routinely use second opinions when discussing cases at a tumor board, referring patients to tertiary centers or consulting international experts.
Patient-initiated second opinions are initiated for some of the same reasons – the search for reassurance and certainty – but also for other reasons, such as distrust, dissatisfaction and the need for more personalized information.
Evidence of the clinical value of second opinions in cancer is limited. In one review, a second opinion usually confirmed the external diagnosis and treatment plan, providing patients with valuable reassurance.
The key message was this: the value of high-quality second opinions was usually derived from de-escalating or adjusting treatment in ways that reduced morbidity rather than improved prognosis..
In other words, a second opinion rarely offers large-scale change; it can be done sooner nuance complex decisionswhich is no small matter for patients.
If a second opinion can be empowering, it can also waste crucial time, cause harm, increase costs and limit access for others. Patients may also end up feeling emotionally worse and more confused, as has happened to 39% of parents of childhood cancer patients in one study.
If you are a cancer patient at any stage of the disease, here are three things you need to know about getting a second opinion.
Don’t worry about causing offense
A patient of mine disappeared from my clinic for several weeks before resurfacing. Her son voluntarily offered renewed confidence in me after a visit to an experienced oncologist who endorsed my approach and graciously added that, as my former boss, he believed she was in good hands.
I told the family that if I had known, I would have saved them the trouble of collecting the paperwork and even helped expedite a second opinion. Surprised by my openness, they replied that they did not want to hurt my feelings. But good doctors are not so fragile of ego and generally curious by nature. We want the best for our patients. No patient should avoid a second opinion for fear of offending a doctor.
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Know what questions to ask
Patients who get the most out of a second opinion need time to process the first opinion and formulate questions.
Is my diagnosis correct? How reliable are my pathology and radiology reports? Is this approach suitable for my individual circumstances? Is any clinical trial right for me? Which side effects are relevant to me? These are crucial questions that can add information and change the direction of care.
Many patients do not doubt the professionalism of their doctors, but rather find them lacking in communication. Rapport is important. Second opinions are often less about reconfirming medical facts than about discovering trust. Excellent cancer care means connecting every cancer patient with nurses, paramedics and mental health providers to fill the gaps left by (even the best) doctors. If a second opinion achieves this, it is a success.
It is never too late for a second opinion
Some patients regret not having a second opinion and believe it is too late. Patients who have started or even completed treatment can benefit from a new perspective, reassessment, and recommendations for monitoring and staying healthy.
The estimated doubling time of medical knowledge in 1950 it was 50 years; in 2010 this was 3.5 years; today it is only 73 days.
Most oncologists are humbled by how little they know about the unfolding universe of cancer. Therefore, their patients should know that second opinions do not have to have an expiration date – and if access to such advice is a problem, they should expect their treating physicians to help. It is not advisable to keep asking for advice without making a decision, but visiting a doctor is not the same as trying to be fully informed. Every patient has the right to a second opinion.
When faced with a life-threatening condition, it is common for patients to wonder who the “best” doctor is. Sometimes the best treatment lies behind an extensive second opinion.