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August 14, 2000
Checking It Twice
How important are second opinions?
By Irene S. Levine, Ph.D.

illustration: Terrie Maile

During her monthly breast self-examination in January, Fran, a 45-year-old working mother from South Salem, New York, noticed a hard, well-defined lump in her right breast. She immediately made an appointment with her family doctor. His reaction wasn't quite what Fran expected. "He wasn't at all concerned and told me not to do anything right away," she recalls.

Fran felt differently, however, and scheduled a mammography appointment herself. After reviewing her X rays, the radiologist referred Fran to a general surgeon for a biopsy. Several days later, the pathology report came back with a diagnosis of "atypical medullary carcinoma." Fran had breast cancer.

The radiologist referred Fran to an oncologist to decide on a course of treatment. Without offering her much information about the relative risks of each procedure, the oncologist asked her to choose between a lumpectomy -- surgical removal of the lump -- with radiation, or a mastectomy -- surgical removal of the entire breast.

"Breast cancer wasn't really their cup of tea," says Fran when asked why she decided to go to yet another doctor. "All of a sudden I was hit with treatment terms that I didn't understand and that weren't explained. There wasn't even any literature around the office that I could take home with me."

Fran decided to schedule an appointment with a breast surgeon, who advised her to have a lumpectomy, accompanied by both chemotherapy and radiation.

But Fran made one more stop along the way. She went to a breast oncologist on the faculty of an academic health center in Manhattan, who sent her slides to another pathology lab.

"He confirmed that I had a stage 2 breast cancer," explains Fran. "He also told me that the long-term outcome for this type and stage of cancer would be equivalent whether I had a mastectomy or a lumpectomy with radiation and chemotherapy. I no longer had any doubts about what I should do. This doctor gave me all the information I needed to make a decision, and the lumpectomy just sounded right."

After successfully finishing treatment last month, Fran is healthy and able to travel with her family this summer. She also has a new sense of confidence in herself. In seeking out doctors with the most expertise in her type of cancer, Fran took charge of her own health care.

Why get a second opinion?

Although most people routinely comparison shop for material items, important medical decisions are often made without the benefit of a second health professional's feedback.

In the new book Second Opinions, Jerome Groopman, M.D. -- a physician and professor of medicine at Harvard Medical School -- discusses the ambiguities of medicine and sheds light on the significance of second opinions.

"Decisions about diagnosis are complex," writes Dr. Groopman. "There are dark corners to every clinical situation. Knowledge in medicine is imperfect. No diagnostic test is flawless. No drug is without side effects, expected or idiosyncratic. No prognosis is fully predictable."

When do you need a second opinion?

Not every visit to the doctor requires a second opinion -- most medical problems are relatively straightforward. Second opinions add expense to your medical bills and are time-consuming. However, they are clearly in order under certain circumstances:

  • When an illness is very serious or life-threatening
  • When a diagnosis or its course of treatment is unclear or ambiguous (either to you or to your doctor)
  • When an illness is rare and you could benefit from consulting with a specialist
  • When you want to take advantage of experimental or additional treatment options available elsewhere
  • When you have any doubts or concerns about your doctor, or questions about your illness or its treatment that your doctor hasn't answered to your satisfaction

How can you find a second opinion?

Don't be shy about requesting a reference for a doctor who specializes in your area of need. To do this, there are several options:

  • Ask your physician for the reference.
  • Check with your local hospital or an academic medical center.
  • Seek the names of good physicians from family and friends, or from people who have had a similar illness.

What will it cost?

Insurance companies often reimburse the costs of obtaining second opinions for expensive surgical procedures. In fact, six states (Florida, Indiana, Louisiana, Missouri, New Hampshire, and New York) have passed legislation requiring medical managed care providers to offer or authorize second opinions.

If you have a less serious medical problem, however, you may have to cover the cost of seeing a second physician yourself. When in doubt, it is always best to check with your insurance provider in advance.

Will it be insulting to my doctor?

Many people, particularly seniors, are embarrassed to ask their doctor about a second opinion. Don't be. No competent doctor should be insulted when a patient seeks advice or consultation with another physician. Because a working relationship between doctor and patient must include open communication, it is essential to choose a health care provider who encourages you to seek additional information.

Michael Finkelstein, M.D., a hospital administrator and an internist, comments, "From my vantage point, a second opinion is always appropriate, unless it creates unnecessary delays in receiving appropriate treatment. When my patients seek out an opinion from another physician, I usually agree with the need. Even if it's not necessary for their medical condition, it may be important for their peace of mind."

Related links:

Outside link: Guidelines for getting a second opinion from the American Medical Association