A Second Opinion About Second Opinions

The medical world often encourages us to get a second opinion before embarking on expensive procedures. While getting a second opinion may seem straightforward, a closer look reveals that the process is not so simple. There are hidden effects of language at work here: First, the word "second" is typically not as good as "first," regardless of what it modifies. Next, if we take the word of our doctor as truth, then what might we expect when we compare "truth" with an "opinion?" Just as second is less than first, opinion is less trustworthy than diagnosis.

In a class demonstration in my decision-making seminar, I asked half of my students the following question: "A doctor tells you that you need surgery. You get a second opinion and that doctor tells you that you don't need surgery. On an eleven point scale ranging from 0 meaning 'definitely not' to 10 meaning 'definitely yes,' how likely are you to get surgery?"
I asked the other half of the students this question: "A doctor tells you that you need surgery. Another doctor says you don't need surgery. How likely are you to get the surgery?" You'll note that for the first group, the term "second opinion" was used but not for the second group. When a doctor gave a "second opinion" the average score of the response was 5. The average response where "second opinion" was not mentioned was 2.5. That is, it became twice as likely that the first doctor's view would be followed when posed against a "second" "opinion."

Dr. John Glick of the Abramson Cancer Center at the University of Pennsylvania has estimated that when patients come to him for second opinions regarding a treatment plan, his view only completely agrees with the first opinion around 30 percent of the time. In another 30 to 40 percent of the cases, he and his colleagues recommend significant changes to the plan. Sometimes his team comes to a completely different diagnosis.
If physicians are all trained in the same approach, they very well may suggest the same course of action, but if trained differently, different opinions might prevail. Thus, we could have physicians viewing the same facts but differing in their views of them and we could have different facts considered by the different physicians.

People often don't get second opinions. Is that sensible? If we got a second opinion, regardless of what the second doctor tells us, she really doesn't tell us what the next fifty doctors would say. One doctor is a very small sample size and as such may not be reliable. On the other hand, there could be a hidden positive side effect second opinions. When a patient and her doctor consider the need for a second opinion, they are implicitly acknowledging uncertainty. Uncertainty promotes mindfulness which is good for our health. So, we're right to get a second opinion, but not because we'll now have better information. Of course, we could save money by not taking this circuitous route by just recognizing the inherent uncertainty in everything and remain open to experience.

Comments

[Ranta]

More important than should you have surgery is why should you have surgery. I value much more the opinion of the practitioner who includes me in the process. The opinion may be wrong but at least then I have a reference point to start a little of my own research.

[decodingyou]

There is also the problem of annoying your regular doctor by getting a second opinion. A friend just played a voicemail she got from her doctor, a gastroenterologist, for me since I see a doctor in the same practice. This doctor said that because she had wanted a second opinion that must mean she had lost confidence in him, and he would treat her for the next 30 days only. He listed several doctors she could consider, then repeated again that she must have lost confidence in him. After hearing that, I told her the voicemail was what would make me lose confidence in him!

[Rovanda]

There's also the issue of money - will my insurance pay for the visit to another doctor for a second opinion? Will my insurance cover the visit, any extra diagnostics, etc? And for those who don't have insurance, there's the question of whether getting a second opinion is worth the out of pocket expense.

For that matter, "will my insurance cover this treatment?" or "how much is this treatment going to cost me?" is almost a second opinion in and of itself. Completely apart from the question of whether a diagnosis is correct is the question of whether you can afford the suggested treatment. A lot of people will even ignore life-threatening conditions in order to avoid expensive treatments that they can't afford.