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Second Opinions

Posted 3/7/2016

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  Have you ever had a second opinion appointment about an important medical decision? Have you thought about doing so? My basic stance on this question is this: If you are thinking about getting another opinion, you probably ought to do so. What you want to avoid is looking back and wishing that you had done so.

  Second opinion appointments can be extremely valuable, but also carry the risk of adding to the uncertainty. What if Doctor #2 makes a completely different recommendation than Doctor #1? Are you then going to need Doctor #3 as a tie breaker?

  Much of the time a second opinion is really unnecessary and a waste of energy, money, and everyone's time. There are clear standards of care for many cancer situations, e.g. early breast cancer, and you will hear the same thing from any good doctor whom you consult. If you didn't feel comfortable with the first doctor or the apparent system at the first hospital or office, that is a good reason to consider going elsewhere, but that is different than thinking that the medical advice will differ.

  There always comes the question about where should you go for another opinion? While it is possible to see a second doctor in the same institution, it is probably smarter to go elsewhere and have a totally different experience. You probably don't need to leave Boston although I have known people who chose to do so. Unless there are compelling reasons to seek another opinion in another city, think carefully about it. Do you really want to have to travel to New York or Philadelphia or wherever for ongoing care? Generally speaking, insurance will cover the cost of a second opinion (but maybe not three or four), but check this out first. It may be worth paying out of pocket, but you do want to know what to expect.

  Here, in my experience, are some of the times that a second opinion can be very helpful.

1. If you are considering a mastectomy with reconstruction, it is usually smart to meet with more than one plastic surgeon. Different ones have different favorite techniques, and you want to learn about all your options.

2. If you have had surgery and staging tests, and the final pathology is back, and you are in a gray area about the need for chemotherapy, it may be helpful to get someone else's perspective.

3. If you are dealing with recurrent or metastatic cancer, and there is not a generally agreed-upon standard of care, there probably are other possible treatments to consider. This is at time when it becomes the art of medicine, and you may want to think about several expert's suggestions.

4. If there are relevant clinical trials available at other institutions, this is the way to learn more about them.

And here is an article from Cancer Net:

Seeking a Second Opinion

Cancer is often a confusing and frightening diagnosis. It may be hard to make decisions about treatment options. Because treatments are continually improving, it is important to find someone who has experience with your type of cancer. Many people seek the knowledge and advice of more than one doctor to confirm a diagnosis and evaluate treatment options. This is called a second opinion.
Asking for a second opinion is common practice. It may help you feel more comfortable with the health care decisions you make.
How a second opinion may help
A second opinion may provide the following information:
Confirmation of a diagnosis
Additional details about the type of cancer and its stage, such as:
A description of where the cancer is located
Whether the cancer has spread
Whether it is affecting other parts of the body
Perspective from experts in different oncology disciplines, such as medical oncology, radiation oncology, and surgical oncology.
Other treatment options, in situations in which the doctor disagrees with the original diagnosis or the proposed treatment plan
What clinical trials are open to you. These are research studies involving people.

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