In an interview with WebMD, Jerome Groopman, MD, author of Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, summarizes valuable lessons from seven life-and-death stories.
After the interview, Lois Trader – heart health authority and women’s heart health advocate shares her additional comments.
WebMD: What situations demand a second opinion?
Groopman: Any time you have a very serious or life-threatening disease:
• Where the treatment is very risky or toxic
• Where the diagnosis is not clear, the treatment is experimental, or there is no established consensus or Food and Drug Administration-approved treatment
• If you're considering participating in a trial for a new drug
• If you're considering some new experimental approach or a procedure that involves using experimental instruments or devices.
Trader: When you are treated like a number, not a person. When you want desperately to believe the doctor you are comfortable with, but your stomach is telling you to get a second opinion. Get a second opinion.
WebMD: We all fear being the "demanding" patient. How should you ask for a second opinion?
Groopman: I think we all want to be polite and civil and don't want to spark an adversarial relationship. Yet, I feel very strongly that any time a patient raises the issue of a second opinion, a physician should welcome and endorse it.
Trader: Quote from my book: Surviving – Dr. Warren Johnston, Cardiology Saint Joseph Heritage writes: It is important to remember as Lois points out repeatedly, that you are your own best advocate. While your doctor remains your best resource to negotiate the complex medical system, if you feel that your questions are not being addressed to your satisfaction, by all means seek a second opinion. No doctor worth his or her salt would ever take offense at that.
WebMD: Should you always tell your doctor if you're seeking a second opinion?
Groopman: Absolutely. One, you need all the medical records and any pathology slides or other test results to give to whoever is giving the second opinion. Two, you want the experts to discuss in an open way what the areas of agreement and disagreement are. If you don't tell your doctor because you're afraid you're going to insult him, it's hard to get the records together and communicate.
Trader: I don’t tell my doctor everywhere I go, I don’t see the reason why I’d tell him I’m having a second opinion, unless I switch doctors and I feel like answering the call I get which directly asks me why I’m not going to make my appointment or schedule a new one. Even then, it’s up to you.
WebMD: Should you ask your doctor to recommend someone for a second opinion?
Groopman: You can, but it's important to see someone at a different institution. Institutional cultures are real, and often an opinion leader at one hospital will do things a certain way and others at that institution will conform to that viewpoint. But at another hospital, even across town, there may be a very different philosophy.
Trader: Recent example: St. Jude Orthopedics met my mom on May 2nd, after a terrible fall which left her with a badly broken shoulder on May 1st. Almost the very first question after hello, was asking if my mom was part of the community? With my mom in more pain than I've ever seen, without her trusty wig and on strong pain meds, I’m being asked a question that left me wondering if they wanted to know if my mom was running for City Council. I still hit myself in the face thinking that my initial answer was no, my mom is not part of the community. Now if we’re discussing the family as a community, then hell yes, she’s president of the community, top dog, most important, person most likely to win the award of taking care of everyone but herself. 56 days later with my mom in horrible pain and still sporting a badly broken shoulder we sought a second opinion at a different facility. Sadly, and to my dismay, we agreed to take my mom to physical therapy 3 weeks into her broken shoulder ordeal. Something that makes us all cringe now. And something that new orthopedic surgeon called inhumane. The new doctor they looked at the x-rays, talked to my mom about her present health and judged her on physiological age, not physical age. And my mom received complete shoulder replacement surgery within 3 days. That is what a second opinion can do.
Definition: A person's age as estimated by his or her body’s health and probably life expectancy. A person's age estimated in terms of function. The age of an individual expressed in terms of the chronological age of a normal individual showing the same degree of anatomical and physiological development.
WebMD: What if your health plan doesn't say anything about how it covers second opinions?
Groopman: This is one of the major flash points for a patients' bill of rights and the whole issue of managed care. Each plan differs as to the level of choice and freedom you might have to see someone inside and outside the network. If you're restricted, or in a situation where the diagnosis is not clear, or you feel the best treatment exists at another institution, then you need to advocate for yourself quite loudly.
Trader: You should know by now that I am a strong voice for personal advocacy. It’s your life and no one can live it for you. And what your body feels only your body feels. People can sympathize, empathize, and even say they can relate, but no one can really feel what is going on in your own body. You know yourself, listen to your body. If you hear it speaking to you in a voice you haven’t heard before, listen.
WebMD: A recent study of biopsy slides at Johns Hopkins published in the December 1999 issue of the journal Cancer showed a surprising rate of misdiagnoses. Is it realistic to ask for a second medical and lab or pathologist opinion?
Groopman: Always. Absolutely. I saw a woman recently who had sought three "second" opinions in Boston. She had been diagnosed with a breast cancer that was characterized by the genetic marker HER2, a marker for a very aggressive breast cancer. If staining of the tissue by a pathologist shows this, it means that you're eligible to be treated with a new medication called Herceptin. It also means you have a much more aggressive form of cancer and need chemotherapy immediately.
Trader: Here are some helpful links:
American Heart Association's - Second Opinion
Thanks and here's to your health, your first and second opinion and your advocacy along the path.