Trust Your Doctor? When to Get a Second Opinion

If you're received a serious medical diagnosis, you should consider seeing another physician for a second opinion. Not because you shouldn't trust your first doctor, but because you need to become as informed on your illness as possible and different points of view can help you in considering your options for treatment.

The following are seven considerations you should always keep in mind when getting a second medical opinion:

1. Is there agreement?

The obvious and key question to begin with is "Does the second doctor agree with the first diagnosis and the implications of it?" If not, you should consider getting yet a 3rd opinion and even a consultation at a University hospital or academic center.

2. What are the two to three best treatment options?

What are the two to three best treatment options and what are the benefits, risks, and cost of each? Unfortunately, medicine as a business and economic factors often cloud a practitioner's judgment. This is not because they mean to intentionally misguide you, but there are financial incentives involved and you need try to understand their potential influence on the doctors.

In medicine, this is a problem in a couple of ways:

1. Virtually all of most physicians' ongoing medical education is paid for by the drug companies and represents slick advertising masquerading as educational activities. This even includes most of the studies in well-known journals. These studies are paid for by the drug companies and the journals' main source of income is often drug company advertising, an obvious potential conflict of interest. Research shows that a study paid for by a drug company is often not reliable (as much as 40-2,000 percent more likely to show a positive result than an independently funded study!). Most doctors think that they are being responsible and scientific when in actuality they are pushing expensive and often toxic new medications and treatments — that are not as effective as lower cost natural or generic therapies.
2. If the procedure is done by the recommending physician and is a source of their income, then there is a heavy bias to believing that it is good for the patient. I remember decades ago while in my internal medicine practice that recommending a special heart monitor called a "holter monitor" was quite profitable. As a physician, I was easily convinced that this would save people's lives by picking up dangerous abnormal heart rhythms for treatments. I remember the resistance I had to believing new research showing that this test was overdone. Yet it turned out that it was.

Because of this, it is good to get a choice of treatment options, preferably including natural options. Natural options will have to come from a holistic physician, as most standard physicians are taught that natural remedies are quackery — which in medicine is often just another way of saying the option is "not good business." A good holistic physician is more likely to guide you based on the science and research of natural remedies (though there can also be financial biases in holistic medicine).

3. What if I do the more conservative treatments recommended by my first physician, or nothing at all?

For most medications or medical procedures, presume the risk is a bit higher than reported, as most studies are done in "best case" scenarios. Because of this, if the risk of a conservative approach is really not much higher than the recommended treatment, I personally will tend to choose being conservative. To put this in perspective, my reading of the data suggests that deaths from medications and medical procedures is the fourth leading cause of death in the U.S. — and is largely ignored by standard medicine.

4. In serious cases involving life-prolonging treatment options, what are the differences in quality of life?

In cancer treatments, for example, it isn't enough to only ask whether one treatment will prolong life over another. If the treatment prolongs life by one week, but leaves the patient largely incapacitated for two months when they only have six months of estimated time left, and the treatment leaves the family bankrupt to boot, it may not be something you want to choose. Nonetheless, many physicians have no clue whether a treatment will prolong your life by a week or a year (the drug companies only give them whether there is a statistical difference). Knowing the different benefits expected from different treatment options, particularly when those treatments are likely to be toxic or expensive, is a very important consideration.

5. Get the second opinion from a physician that has a different background.

In general, if the first opinion came from a doctor in a specific specialty area, consider getting the second opinion from someone of a different but related specialty. If getting a second opinion on surgery, consider getting the opinion from a non-surgeon.

6. Consider getting a second opinion from a holistic physician.

A holistic physician can offer a very different set of options (visit the American Board of Integrative Holistic Medicine for help finding one).

7. Bring a friend and a tape recorder with you.

Finally, bring a friend, family member or other advocate with you during the physician visit, along with a tape recorder. Ask the physician if you can record the visit so that you can review and better understand what they told you. Because of the legal climate, some physicians may be uncomfortable with the visit being recorded, and if this is the case honor their feelings (or the information they give is likely to be so hedged as to be useless). Personally, as a physician, I have encouraged my patients to record their visits for over 20 years (and had a tape recorder in my office that they could use), as it helped me to give them the needed information more quickly and clearly.

 

 

 

Comments

[BTHARRIS]

12:37 PM on 06/17/2011

When getting a second opinion after a biopsy make sure your physician obtains the slides and reports from the biopsy and seeks advice and review by another trusted pathologist with expertise in the designated field. Pathologists are physicians specially training to interpret laboratory tests, biopsies, and clinical information to provide a diagnose to patients and their treating physicians.

[SoCalDoc]

12:53 AM on 05/09/2011

As a physician, I always recommend patients talk to as many sources and read as much as they can about their illness. I also caution them to review the credentials of the professionals they talk to and the sources they read on the internet. If a patient indicates they would like a second opinion from a physician, I try NOT to influence where they would go, but I try to steer them away from professionals that I feel would not be helpful to them in making a decision. I painstakingly spend time reviewing their illness and treatment options with them during the first few visits. Physicians too often are offended if a patient indicates they would like a second opinion; I welcome it, as the majority of patients end up back in my office stating that they did their research and are comfortable with the decisions they've made. It also assures me that I am keeping up with the recent advances in medicine and am practicing good quality medicine.

[leejcaroll]

03:02 PM on 05/06/2011

I was surprised at the suggestion: "Consider getting a second opinion from a holistic physician. " Then I went to Dr. Teitlebaum's website where he has a store. Reputable docs rarely sell pills called "happy pill" or "end fatigue now". A book subtitled a "proven way to program for eliminating chronic pain now". is false hope for those who live with chronic intractable pain. I see someone here had success with this doc's online support info. I am glad for you but the fact is, esp for those in chronic intractable pain, the answer is not a simplistic one as this doc would have you believe. 2nd opinions, if you have ins to pay, are an excellent idea and can also assure you that your doc is legit and offering legit info and answers.
Carol Levy
author A PAINED LIFE, a chronic pain journey
http://apainedlife.blogspot.com/
http://womeninpainawareness.ning.com/

[Paleo Man]

10:18 PM on 04/28/2011

I got my "second opinion" online in a superb article by the above author Jacob Teitelbaum MD. I had GI issues and a primary care doc automatically put me on the purple pill, proton pump inhibitors, for months. Whenever I tried to stop the PPI's, I had severe rebound hyper-acidity. Later it developed that gluten intolerance was the cause of my GI issues, but I couldn't get off PPI's. Then I read an excellent protocol by Dr. Teitelbaum that he had generously posted online and was able to wean myself off the drugs without excessive discomfort. Now I've gone years without the slightest GI discomfort or reflux and without using any drugs. Many thanks to Dr. Teitelbaum for his generosity and wisdom and natural approach.

[VA Jill]

02:18 PM on 04/28/2011

The good doctor is one who KNOWS what s/he doesn't know. The better doctor is one who knows who DOES know. If yours is one who knows neither of these things but insists on treating you themselves, beyond their own skill level or ability, or refers you to someone just because they're a buddy, FIRE THAT DOCTOR! Too many people are afraid to "hurt their doctor's feelings" by doing that.

[markplathom]

02:03 PM on 04/27/2011

Turned my knee about 3 years ago, went to my insurance providers web site and picked out the closest sports medicine Dr i saw and went for a visit. He said "You got a PPO, let's put you on the table and cut you open. You'll never be able to run in anything other then a straight line if we don't." 2nd Dr said "Let's wait and see what happens." Here i am 3 years later and my kneee feels fine, I used to HATE running, now everytime i turn and burn i make it my personal FU to that d#ckhead Doctor out for money.

[PersonalityPlus]

11:51 AM on 04/27/2011

This article makes you trust no one! #1 doctor gives you a diagnoses . Then you go see doctor # 2 to confirm if its a true factual diagnosis or a lame diagnosis, or if this 2nd guy differs with the 1st. Oh gee now see #3 to see if he differs or agrees with 1 & 2 . Why even go if your have to go see so many to even start to think you can trust any of them?

[DennyCrane]

08:53 AM on 04/27/2011

Explain to me how I can trust my doctor when I have no idea if he's getting money from drug companies who want him to push their products onto his patients. Explain to me how I can trust my doctor when he only took one semester on nutrition in med school and then tells me my diet is unhealthy. Explain to me how I can trust my doctor when he his compensation is based on how many tests he runs and then tries to defend it by saying he's just afraid of being sued. I'm not saying all doctors are untrustworthy. But the bad ones really give your profession a bad image and make many of us reluctant to even see a doctor. I once suffered from depression and my doctor put me on anti-depressants. It didn't really help so he just increased the dosage. Finally, I took matters into my own hands and read up on depression and its causes, which doctors claim are unknown. I discovered depression is linked to diet. So I changed my diet, started exercising more, and my depression went away. Then you have people with severe acne. Their dermatologist gives them Accutane and tells them that diet has no connection to acne. Then how do you explain people cutting out dairy and processed foods who see their skin clear up? The answer is that there's no money in telling people to eat healthy. But there is money in drugs and tests.

[MommyMD]

01:07 AM on 04/27/2011

Most aspects of this post are lovely...however: If you do chose to see a natural/integrative medicine doc, understand that that they may harm you as well. "Big Pharma" exists along with "Big Placebo" and "Big Integrative Medicine." Most MDs do NOT get paid for your medication (insulin, for example, in my practice). But your naturopath does get paid in cash for his/her vitamins/remedies/and mixtures.
Also, many MDs are not in any way against integrative treatment as long as it has real (peer-reviewed/top journal) evidence behind it. This post sets up a false dichotomy between "traditional" and "integrative" medicine.

[NotEve]

10:24 PM on 04/26/2011

In general I agree with the basic premise of this article: second opinions are a good thing.

But, I must protest Dr. Teitelbaum's misleading assertions regarding natural remedies and holistic physicians.

firstly, holistic medicine is just as easily practiced by MDs & DOs. To suggest otherwise is uninformed.

secondly, its true that MDs/DOs dont get much training in 'natural' remedies, but for a reason: Medical training is focused on evidence based medicine. The problem with 'natural' remedies is theyre unreliable. A certain plant may contain an organic compound with therapeutic benefit -in fact many "unnatural" (?!) medications are based on the isolation of these compounds, which are a major source of investigation-, but they aren't regulated or standardized. Which means that it's virtually impossible to accurately prescribe and dose such treatments.

Frankly, there's no such thing as 'natural' medicine. All medicine, whether herb or pill, is a drug that has physiological repercussions. Its naive to think that just because its a plant or mushroom it will be better for you. In fact there are all kinds of drug interactions, toxicities, and nasty side effects that can occurr - and much less research and standardization to prevent it.

Furthermore, its naive to think holistic meds are any less influenced by big $$.

I agree that the integrity of scientific journals have been compromised. But as a med student I can also tell you that my education has informed me of this and how to avoid being unduly influenced by it.

[sugarcreekchile]

01:54 PM on 04/27/2011

I'm surprised to see an M.D. advocating consulting a holistic physician for a second opinion. Holistic medicine is described as approaching health and disease from several angles. The approach suggests that a person should treat not only the illness but the whole self to reach a higher level of wellness.
For example:
Practitioners may treat cancer by changing diet, behavior and adding social support groups and counseling. Others may suggest taking botanical supplements and using complementary therapies, such as art therapy, hypnosis, imagery, meditation, psychotherapy, spirituality and prayer, and yoga. These approaches can be used with conventional treatments such as chemotherapy, surgery, radiation therapy, and hormone therapy. Combining these different methods can help a person take control of his or her situation and attain a feeling of total wellness -- spiritually, physically, and mentally.
To me, consulting a holistic physician for a second opinion would be a complete waste of money. If I have a serious condition, my coping skills are sufficient enough to sustain me. I don't need to go see Dr. Feelgood. Sitting under a pyramid in the lotus position chanting "ohm" isn't going to cure my disease. A positive outlook can indeed be an asset in recovery and I am a believer in prayer but when it comes to my health, sniffing essence of nasturtium flowers isn't going to do anything to improve my mental outlook. I'll stick to conventional medicine and consult specialists for opinions. I'll not be buying snake oil from a traveling medicine show.

[frank day]

09:42 PM on 04/26/2011

Great Advice!

My wife and I always accompany each other to physician appts..

I think this is advice is doubly important if the treatment involves anything invasive such as surgery.

Be sure to check with your insurance company as well to see whether the course of treatment will be paid for.

[Haleh Rabizadeh Resnick]

09:39 PM on 04/26/2011

As I share in Little Patient Big Doctor: One Mother's Journey, it is extraordinarily important to trust yourself through the process. Until you feel comfortable with the path your health is taking don't stop getting that next opinion.

[practicalnomad]

08:47 PM on 04/26/2011

Sounds like great information, however, most Doctor's appointments allow 15 minutes. Doctors want to rush and do more talking than listening. Second opinions are a great idea, however, appointments aren't inexpensive these days and a Doctor's office only interest while scheduling your new appointment is - who is your Insurance company? If you don't have their prefered Insurance, good luck getting an appointment through the front office! The biggest problem with the majority of Doctors is their preconceived notions. They don't judge individuals any longer, they judge past experiences collectively. Only the patient suffers, in ALL the above.

[RMankovitz]

03:45 PM on 04/26/2011

In my opinion, the peer review process is now available for hire. As for the validity and quality of current medical research, check out these links and come to your own conclusions:

Lies, Damned Lies, and Medical Research: 90% of Medical Research Is Wrong?
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

Why Scientific Studies Are So Often Wrong: The Streetlight Effect - http://discovermagazine.com/2010/jul-aug/29-why-scientific-studies-often-wrong-streetlight-effect

Correlation or causation? In research, bet on the former - http://latimesblogs.latimes.com/booster_shots/2010/02/correlation-or-causation-in-research-bet-on-the-former-.html

Is U.S. Health Really the Best in the World?
http://www.jhsph.edu/bin/s/k/2000_JAMA_Starfield.pdf

The above are just some of the reasons I favor primary illness prevention, examples of which can be found in “The Wellness Project.”

Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization

[TXfemmom]

02:26 PM on 04/26/2011

Always check and see who paid for the study.  I find that many of the best studies are conducted in Europe at the behest of their health care units for the countries, as most want to know what works first of all, and the best way to get the needed results for the lowest cost.