3. Go for two
No doctor knows everything. Here's how to get another viewpoint
It's tough to go up against godlike powers, to confront someone viewed with reverence, who can exacerbate illness or offer cures. It's hard to take on the almighty--to tell a doctor that you want a second opinion.
"Patients often feel their doctors are God. This is someone they've seen and trusted, perhaps delivered their children," says Carla Dionne, executive director of the National Uterine Fibroids Foundation, a patient support group. They worry about making their first physician angry. "People have to get over that hurdle, because it can hurt them," Dionne says. "It's astounding to me, for example, how many women with uterine cancer let their general gynecologists do surgery on them. They don't go to a gynecologist-oncologist."
A second opinion is a fresh set of eyes, a new degree of knowledge, brought to bear on your condition--and the difference in doctors can make a difference in care. In breast cancer patients, one study showed that a second exam by a specialist changed treatment options for 20 percent of the women. And for patients with liver problems, a review of their tests by pathologists specializing in liver disease revealed new information--like the presence of cirrhosis--nearly 30 percent of the time. "If your doc hasn't seen a condition like yours before or has only limited experience with it, a second opinion can be quite useful," says Deepak Bhatt, an interventional cardiologist at the Cleveland Clinic.
But it can be daunting to look for the right expert. There's no yellow pages category called "Best doctors who know the most about your particular situation who are also in your area and who are covered by your insurance plan." Yet by putting together some easily obtainable information--from friends and families, from other doctors, and from the Internet--you can figure out four crucial things: when you need this extra help, where to find it, what to do with the advice, and how much it will cost you.
When to ask. If you have a complex condition, like blocked coronary arteries after two bypass operations, then a second opinion is a good idea. It won't change a diagnosis but might give you more treatment options: artery-opening stents, for instance, instead of more surgery. Likewise, get that other opinion if the treatment your doctor currently recommends has severe side effects or involves major surgery--or if it isn't working. And "if you aren't communicating well with your doctor, look for someone else," adds Monica Morrow, a surgical oncologist at Fox Chase Cancer Center in Philadelphia.
Communication trouble can have serious repercussions. Yong Staranowicz, a 64-year-old from Appleton, Wis., was diagnosed with lung cancer this past summer. Her oncologist, she says, "was all doom and gloom." So she decided not to have any treatment. But a friend persuaded her to see a lung cancer specialist at the University of Wisconsin's cancer center, Sarita Dubey. "Dr. Dubey explained things a lot better. She told me how chemotherapy could ease my symptoms. I liked her tone. She gave me courage." In fact, Dubey recommended the same chemo as the first doctor did, but--now aware of the benefits--this time Staranowicz decided to do it. She even went back to her initial oncologist, near her house, to get the chemo.
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.
This story appears in the November 8, 2004 print edition of U.S. News & World Report.