Tuesday, May 21, 2013

How to get an effective second opinion

Patients are often confused when exploring their treatment options. This is not surprising , because there are now so many choices ! When they are confused , they turn to their doctor for medical advice. Patients understand that doctors don’t have all the answers , which is why they will often get a second opinion to confirm that the advise which the first doctor gave was reliable or not. For example, if a patient has endometriosis, she goes to a gynecologist who advises her to do a laparoscopy to make the diagnosis and to treat the disease. She is understandably uncomfortable about subjecting herself to surgery, which is why she gets a second opinion from another gynecologist. When this doctors also says that a laparoscopy is the next step, since she has now been to two different doctors , both of whom arte advising the same surgery, she is comfortable that she is on the right track , and goes ahead with the laparoscopy. Unfortunately, this is flawed thinking. The trouble is that when you have a hammer, you end up seeing only  nails ! Lots of gynecologists respond in a reflexive manner when they hear the word endometriosis . Their standard advise is to do an operative laparoscopy , in order to remove the endometrial lesions. Their worldview seems to be that the endometrial deposits cause fertility problems;  and that whenever there is something abnormal, the best thing to do is to just take it out – just like all lumps in the breast need to be removed.

It’s quite easy to sell the patient on the idea of doing a laparoscopy. For one, it make logical sense. Isn’t it important that the doctor take a look inside the belly, so he can see exactly what’s going on ? Also, most doctor emphasise now easy laparoscopic surgery is today. It’s a simple procedure which does not leave a scar. It takes a few hours and the patient doesn't even need hospitalization because it’s”  minimally invasive surgery “.

This is why a lot of patients with endometriosis end up doing surgery – and the surgery actually reduces their fertility ! This is partly because the endometriosis is minor – it’s a red herring which wasn't really affecting her fertility and could have been safely left alone. However, once the doctor is in the OR, he has to complete what he started. Along with removing the chocolate cyst, he also removes normal ovarian tissue , thus reducing the patient's ovarian reserve and causing her to become infertile !

This is the biggest tragedy of going to two ( or more) doctors of the same specialty for a second opinion. They share the same world view – and their advise is likely to be very similar. This is why you should actively seeks out a second opinion from a doctor with a different perspective ! You will get a much more balanced viewpoint, so that you can understand both the pros and cons of a given option. Thus, you should seek out an IVF specialist , who will try to convince you why you should not be doing a laparoscopy , and why you’d be better off doing IVF instead.

It’s true that different points of view may end up leaving you a little confused , because it's hard to sort out what's right. Still, it's better to be confused because you know a lot, rather than make the wrong decision because you don't know any better. This ignorance can come back to haunt you afterwards !

Also, if a doctor says I think you should do surgery , one of the first questions you should ask him is - Can you give me good reasons as to why I should not do the surgery ! A good doctor will understand your question , and will answer this appropriately . He will be able to explain the pros and cons ; share his biases ; and will be able to justify his advise.  Unfortunately, there will be some doctors who will get affronted and upset about the fact that you are challenging their authority .

If your doctor gets angry because you ask questions, this just means that the doctors not very confident about his opinion - and you're actually be better off finding another doctor can give you a more thoughtful,  rational , and well reasoned opinion , which you can be comfortable . If you find you are scared to ask your doctor questions , this means that something wrong with your relationship with him – and you need to fix this before matters gets worse. If the doctors makes you feel uncomfortable when you ask questions, this means the chemistry between you and the doctor is not right, and you’d be better off finding someone else . A good doctor values a patient’s questions , and will do his best to answer them respectfully !

1 comment:

  1. Good one to know why second opinion of the same variety is flawed.(though not true in all cases). In this article patient has been treated as "above average" and I like it(though a lot is desired in this area on the patient side). One of the best ways to solve this is to keep a well-experienced GP as your family doctor and keep going back to them with all kinds of opinions. I have lots of case-studies to substantiate this. Good point on why more opinions and getting confused is better than wrong decisions. Good one. Keep them coming.

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