Seeking a Second Opinion

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Why and how patients should get another opinion about their diagnosis and treatment.

Every patient has the option to get a second opinion about any aspect of diagnosis or treatment. In fact, getting a second opinion is common, and several situations could actually call for one.

Whether there is concern about a recommended treatment or just a desire to hear the diagnosis confirmed from another physician, a second opinion is appropriate. A patient might also seek a second opinion if the pathologist is having difficulty making a diagnosis, if he or she has a rare type of cancer that their doctor is unfamiliar with, if the patient thinks the doctor underestimates the seriousness of the disease or if their medical insurance plan requires one.

Patients can request a second review of their pathology slides or another opinion about treatment if their choices are numerous and they want reassurance they have chosen wisely. A second opinion can clarify a diagnosis or provide treatment options about which a patient was not aware, including those offered through clinical trials.

Find Referrals

Patients should seek a second opinion from a physician outside their current doctor’s practice. They shouldn’t worry about offending their doctor; most oncologists expect patients to seek a second opinion. Some suggest it and offer recommendations.

Many local hospitals, regional cancer centers and institutions, including the National Cancer Institute (cancer.gov) and the National Comprehensive Cancer Network (nccn.org), have physician referral services that provide consultations for second opinions. Some large cancer centers have formal second-opinion programs designed to provide advice quickly. They do this by scheduling patients to see doctors of different specialties all in one day. In addition, some cancer centers offer second opinions from afar, based on records and images that are sent to them. This allows patients to seek second opinions from top experts without traveling.

Seeking a second opinion from an expert in the patient’s specific cancer can provide another viewpoint. Such an expert could suggest clinical trials the patient’s doctor might be unaware of or confirm a treatment recommendation.

People in support groups and other cancer survivors can also be good sources for recommending oncologists and specialists.

Patients can also identify experts through scientific journal articles about their cancer types. Doctors who have authored several articles on a particular cancer are generally considered experts and might be available for a second opinion and consultations. Patients should inquire about online or telephone referrals, especially if they want a second opinion from an expert at a large cancer center or one who practices far from where they live. Be aware, however, that consultations can be expensive and might not be covered by insurance.

Cover All the Bases

Before seeking a second opinion‚ patients should obtain information about their disease, including diagnosis, staging, treatment options and how recurrence might be prevented. They should ask their physician to send test results and imaging scans to the consulting doctor. Patients might need to repeat some tests, but the second doctor will want to look over existing test results and scans.

Some insurance plans cover, or even require, second opinions before approving payment for treatment. Some plans limit coverage to certain physicians or hospitals, so it is always best for patients to consider their plans when coordinating second-opinion appointments.

Weigh the Options

Some patients might get confused about what advice to follow if the second doctor recommends a different treatment, which might be likely if their cancer does not have a set standard of therapy.

For example‚ both surgery and radiation therapy might be suggested as options for a patient with early prostate cancer, because both treatments have excellent long-term cure rates. A urologist who specializes in prostate surgery might be more inclined to recommend surgery than a radiation oncologist would. In that case, the decision would depend on how the patient weighs the side effects of each treatment in relation to his own personal views and lifestyle. A patient’s primary care physician could also have helpful advice about weighing inconsistent recommendations.

Patients might also want to seek a third opinion if they are still uncomfortable with their diagnosis or treatment options. Although it might not be necessary for their cancer to be treated by a specialist, they might want to hear the opinion of someone who focuses only on their type of cancer, especially if their first two doctors recommended different therapies or had conflicting diagnosis results.

After weighing the options, patients must decide on their medical teams. Most patients proceed with their initial doctors, but comfort level, proposed treatment options and medical expertise should all be evaluated when making a decision.