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Thank you doctor, may I have another -- its second opinion time.

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A prompt, accurate, and complete diagnosis is critical to correctly assessing and treating cancer. Cancer patients should almost always obtain a second opinion and sometimes even a third. Chicago Blood Cancer Foundation, The American Cancer Society, the American Society of Clinical Pathologists, and most knowledgeable patient advocates recommend obtaining a second opinion for every cancer diagnosis. As a patient or caregiver, here are some things you should consider in connection with second opinions.

It is not enough just to obtain a second opinion. You must obtain a proper second opinion. First, a second opinion must be broad enough in scope. Generally, the second opinion should encompass the diagnosis, prognosis, treatment options, benefits and risks associated with the treatment recommendations. However, sometimes -- particularly for a patient dealing with recurrent or refractory disease -- the scope of the second opinion may be more tailored.

Second, the second opinion must have an adequate foundation. A second opinion that is predicated solely upon review of the medical and test reports alone often is insufficient. It is better to have the second doctor and institution review the actual pathology, interpret the scans and tests (in some cases take their own), run critical blood work, conduct a thorough physical examination, and take a complete medical history. This way, the second opinion will not only reflect interpretations of the second doctor from the tests, but also will detect possible errors or inadequacies in the pathology, blood work, and imaging (both the tests themselves and their interpretation). Generally, the doctor rendering the second opinion will obtain the records from the patient or directly from the institution. Providing the medical records and the first doctor’s diagnosis and recommended plan has the clear advantages of providing information to the second doctor and eliminating duplication. It also can influence the second opinion. Sometimes, a patient may not wish to tell the second doctor what the first doctor has recommended until speaking with the doctor rendering the second opinion.

Selecting the right doctor and institution for the second opinion also is fundamentally important. It usually is best for the patient to select the doctor rendering the second opinion (after conducting research and obtaining input from other sources) as opposed to merely going to someone recommended by the first doctor. In Battling and Beating Cancer – The Cancer Survival Book, we have a chapter dedicated to selecting physicians and health care institutions. Usually it is best to obtain a second opinion from a second institution to avoid bias and to have another team review your pathology, diagnosis, and treatment options. We also generally going to a comprehensive cancer center or academic institution with extensive experience in the relevant cancer and treatments. Sometimes, patients will select a leading institution for the second opinion even if travel is required. This may allow you to not only have the initial input of that institution, but to have it involved in monitoring or even directing your care.

The effort and expense necessary to obtain a consultation can be rewarded by the comfort of knowing that an original diagnosis was indeed correct. When a second opinion produces a different diagnosis or treatment recommendation, at a minimum it provides you with information and options. It also may identify a misdiagnosis or incomplete diagnosis or produce a better treatment plan.

Where there are conflicting opinions or recommendations or if you are not comfortable with the opinions that you have received, you may want to seek the opinion from yet another doctor. Many medical institutions have tumor review boards and panels in which cases are presented to a group of doctors to obtain their input and thoughts regarding diagnosis, further work-up, and treatment.

Either way, cancer presents too great a danger to not get a second opinion. Further, with all of the emerging options and the fast pace of developments, you want to take advantage of available options and will be well-served by seeing another set of physicians. In selecting treatment options, consider any discipline bias that may exist. Physicians specializing in stem cell transplants, for example, may be more inclined to recommend a stem cell transplant. Make sure that you have explored your treatment options sufficiently before embarking upon treatment.

Most insurance plans cover second opinions, but check with your insurer to make sure it is covered and to ensure that you comply with any requirements and obtain any necessary approvals.

Keep in mind that obtaining a second option may not be a one-time event. Many patients have cancer that is a chronic condition. In view of the pace of developments, it is important to review options and obtain consultations periodically to ensure that you have up-to-date information.

Even if you are in the hands of a leading physician at a leading institution, you should obtain a second opinion. Your doctor should not take issue with your seeking a second opinion or pressure you to go to a particular doctor for the second opinion. Indeed, if your doctor discourages you from seeking a second opinion or appears to be offended by your request, you are likely in the wrong hands.

Once you are confident in the diagnosis, you have to make determinations regarding what treatment to undergo.

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