Dr. Vicki Rackner

Article Summary:

Second opinion how-to for talking to another doctor and why you should.

Second Opinions

It looks like I'll have a healthy apple crop from the gnarled old tree that sits in the middle of the yard. Although the apple tree will produce apples even if it were neglected, pruning increases its yield. As I stand away from the tree I identify the braches that will get cut. When I get under the tree I loose perspective and it's hard to identify the same branches I saw so clearly from a distance. I find myself cutting a branch or two and then stepping back to make sure I'm on track.

You want to enjoy the fruits of your health. You can let nature take its course and hope for the best. So, too, you get a better harvest of health by taking proactive steps. Undergoing a medical intervention is much like pruning. Getting a second opinion is like stepping back away from the tree and making sure you're on track. Just as the cut branch is gone forever, some medical interventions cannot be undone.

Patients often say to me, "I really like and trust my doctor. Do I need a second opinion?" Here's my answer, "Only if you want top quality care."

When I ask, "What keeps you from getting a second opinion, here are some answers I get:

  • "I never even considered it." In some families and communities, this simply is not done. Please consider it.
  • "It's too much trouble." If you need a second opinion, your life is most likely turned upside down by your medical condition for which you need the second opinion. It is true that setting up a second opinion consultation requires an investment. You must identify a good doctor to see, maybe make travel plans and collect your medical records, x-rays and pathology slides. And you're scared and you might not be thinking straight. I remind you of this: Poor medical choices can lead to huge trouble. A second opinion is a good investment.
  • "I don't want to get my doctor mad at me." You may worry that your doctor will be offended if you get a second opinion. You're afraid a second opinion says that you don't trust your doctor. You don't want to hurt your doctor's feelings. These are all perfectly normal concerns.

Here are some other things to consider. When I step back from the apple tree it's not because I question my skill as a gardener; it's to gain perspective. You and your doctor are right there together under the apple tree. A second set of eyes is much more likely to see something that you and your doctor might have missed because you're too close.

You and your doctor are on the same team shooting for the shared goal of quality healthcare so that you enjoy optimal health. When investigating possible treatment options for your medical condition, your doctor might even call a known expert in the field colleague. I assure you that your doctor, if in your shoes, would get a second opinion, even if it takes the form of an informal chat with a colleague in the doctor's lounge instead of a formal consultation in the examining room.

Please consider going to a known expert in the field who may be involved in a "center of excellence" for your medical condition. There is nothing like experience to hone clinical judgment. The expert may not be a provider under your insurance plan. You can suggest to your insurance company that they pay for the consultation as if the expert were an identified provider. You can remind them it's in their best financial interest for you to get top-quality care, thereby and avoid the costs of sub-optimal care.

You do not your doctor's authorization or consent to get a second medical opinion. Although I am not suggesting you lie to your doctor, I remind you that you have a right to a second opinion and you do not have an obligation to tell your doctor that you're seeking one out. If your doctor challenges you, please just throw up your hands and say, "Dr. Rackner insists."

  • "I don't have time." There are some true life-threatening medical crises that require immediate care. These are problems with the ABC's - airway, breathing and circulation. If you are choking, you need immediate help. Do you know how to perform the Heimlich procedure for an adult and for a child? If your breathing is impaired or you are losing huge volumes of blood or your heart stops you need immediate intervention. If you are in extreme pain it feels like an emergency.

    For most other medical conditions it's perfectly safe to take the time to get a second opinion. Forty years ago, there was a sense of urgency about removing cancer. We realize that a day or two or even a week will make no difference whatsoever in your outcome in the management of most cancers. You are not harming yourself by taking time to get a second opinion.

  • "I trust my intuition, and the choice feels right." That's great. Use your second opinion to run this by a different doctor.
  • Any time you face a big medical choice or wonder if you're on track, you are best served by getting a second medical opinion. And remember, an apple a day...

    Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, "The Personal Health Journal", will help you understand and direct your loved one's health story. Empower yourself with the tips and tools that will help you partner with their doctor more effectively & save your loved one's life at www.drvicki.org.

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