3. Go for two
No doctor knows everything. Here's how to get another viewpoint
And he didn't get angry that she had consulted someone else. Most doctors don't, despite patient fears, says Bhatt. Adds George Petrossian, a cardiologist at St. Francis Hospital in Roslyn, N.Y., "I value my colleagues' opinions. I don't take them as slights."
Where and who. For a worthwhile opinion, says Morrow, "you want someone who sees a lot of patients with your particular symptoms or disease." You can start with your own doctor and ask for a specialty referral. Just make sure the referral isn't to someone in the same practice--you don't want a rubber stamp by a coworker.
One good place to look, say Dubey and others, is at nearby academic medical centers. They combine clinical care with research, so they are often up on advanced treatments or clinical trials not available at community hospitals. Many give comprehensive evaluations by a team of doctors.
William Parker, chair of obstetrics/gynecology at St. John's Health Center in Santa Monica, Calif., has another trick: Call a local hospital with a good word-of-mouth reputation and ask for the head nurse in, say, the gynecology unit. "Explain your situation. They know the local doctors and who's good. They'll be willing to give you some names," Parker says.
There are other sources. Patient support groups populate the Web. These are people with similar illnesses and experiences, and they offer names of doctors and other advice. The problem, of course, is that some advice is just plain terrible. "But you can tell," Dionne says. "Read the message boards of these groups. Are the posts angry? That's not a good sign. Click on the 'about us' link. If it's not obvious who the sponsor of the group is, go away. Good posts refer to medical articles or cite the medical database PubMed--not women's magazines."
What to do. Before seeing the new doctor, make sure he or she sees your old tests. That means the first doctor should send X-rays, lab tests, and pathology reports. (It's also a good idea to call a day or so before your appointment to make sure the tests got there.) Specialists usually work with specialty pathologists, who can pick up nuances that mean, say, the difference between a lumpectomy and a mastectomy.
It's crucial to ask the specialist about options. When patients simply state, "I don't want a bypass," that doesn't require a real response beyond sympathetic murmurs. Turn it into a direct question: "Do I need a bypass? What else is available?"
If the first and second opinions don't agree, then patients need a tiebreaker. And that's not necessarily a third opinion; often that just adds confusion. Take a look at the qualifications and experience of the two doctors. Who inspires more confidence? Which treatment plan are you more likely to follow, and why? These answers will clarify your feelings and the reasons behind them and make it easier to come to a decision.
How to pay. The good news is you have a legal right to a second opinion, under the federal laws that govern most group health plans and Medicare. The bad news is that each insurer can interpret that right differently, some giving you carte blanche to consult anyone but reimbursing at a lower rate and some, mainly HMO s, restricting your choices to their network. Getting prior authorization is always a great idea.
But what if that's initially denied? "What I tell my clients, and this usually works, is that you can get assigned a case manager at the insurance company," says Richard Carter, a healthcare attorney in Alexandria, Va. "That's one level up. And you say something like 'It's been recommended that I get a bone marrow transplant at Duke. But I'd like to see another oncologist first.' That's pretty effective." And effective treatment, by both doctor and insurer, is your goal.
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