Thinking More about Second Opinions

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

MAY 17, 2018

I have written several times about the value of securing a second opinion and the best and less than best times to consider doing so. A short summary: my conclusion is always that If you are considering a second opinion, you should get one. You definitely don't want to look back at some future moment and wish that you had done so now. Remember that no one has any magic, and that all good doctors know what everyone else knows. It can be important, especially if you have a less common cancer, to meet with a specialist. (Side bar here: Twenty years ago, all medical oncologists were trained to care for all kinds of cancers. This is no longer the case in cancer centers or large academic hospitals. At BIDMC, for example, there are oncologists who are specialists in every possible kind of cancer and who spend all of their time caring for patients or doing research about it. In the community or at smaller hospitals, oncologists may still be generalists, and there is nothing wrong with that in most cases. The standard of care for X cancer is the standard of care everywhere, and good doctors will know that.)

Choosing a physician also means choosing the place where you will get your care. Obviously insurance coverage is important, but other things matter, too. Think about the geography and the general feel of the place. Do you feel comfortable there? Is everyone kind and respectful? Are you greeted warmly and appropriately at the check-in desk? Although these details may feel less important at an initial visit, I promise that they will add up and matter a lot over time.

Most important, of course, is the doctor herself. Does she work alone or with an NP or a Fellow? Whom will you see at most visits? How can you communicate with them? How are questions answered? How quickly can you expect to receive a return phone call? Again, details, but details that will add up.

And most important of all is your relationship with the doctor. Like every other relationship in life, the chemistry matters. Does she listen to you? o you feel that you have her full attention when you meet? Is she warm and kind and thoughtful? Very bottom line: Do you like her? If the answer here is No, find another doctor.

From The New York Times comes this essay about this very thing:

Love Your Cancer Doctor? Get a Second Opinion

By Elizabeth S. Bennett

You don’t think twice about getting multiple bids for a construction or plumbing project, so why hesitate on multiple “bids” for your health? I learned the value of a second opinion a year and a half ago when two breast cancer surgeons presented me with very different treatment options. My ordeal began with an acute pain in my breast that I self‑diagnosed as mastitis, an infection that usually affects breast‑feeding mothers. But I hadn’t breast‑fed in 18 months. After a visit to the emergency room and two rounds of antibiotics to reduce the pain and swelling, a lump remained. I had noninvasive ductal carcinoma in situ, it turned out, and lots of it. Some consider this Stage 0 cancer, while others say it should not even be called cancer at all. The diagnosis came just six weeks after my husband, two toddlers and I had relocated from New York to Los Angeles for my husband’s new career. My general practitioner, who was new to me, recommended an oncology surgeon who would be able to see me right away. She was warm, sympathetic, smart and direct. I loved her immediately and knew she was the one for me. Based on my earlier ultrasounds and mammogram, she told me that a bilateral mastectomy would probably be the way to go, because I had breast cancer on both sides of my family. When I flinched, she said that if I preferred, I could have a lumpectomy within the week to be certain of what was growing inside me. Whoa. It was a lot. But I loved her and I was starting to feel better. She ran additional biopsies to see if she could glean more information from the tangle of disease in my right breast. The results confirmed the original diagnosis: Stage 0, D.C.I.S.

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