Why Second … Or Third Opinions Are Important

Office hours can be daunting … for both you as the patient and me as the physician. I want to listen to you, educate you and offer you a potential diagnosis and treatment plan. You want to be seen on time, want to have a chance to speak, and an opportunity to know what is bothering you and what your options are.

Enter second opinions. I take my role as an academic surgeon in a large referral center very seriously. I will see many second or third opinions each day. They are more complex and take more time, especially if I’m not sure that I agree with the first opinion.

Times certainly have changed. I clearly remember agreeing with most other opinions over a decade ago. Interestingly, or perhaps “understandably (not)” as payments to physicians were cut, indications for surgery seemed to go up. Patients with knee pain which would likely improve without surgery were being told they “needed” surgery .. and seemingly for all the wrong reasons.

Today, I find myself agreeing with very few initial opinions. Patients simply aren’t being educated enough about their issue, nor the options available. Now, to be fair, evidence doesn’t exist for all the issues we deal with, but it does exist for 70% or so of the common maladies I see day in and day out.

You need to understand that surgery is often not the answer, not the quick fix, and can often lead to unintended consequences, unmet expectations and significant ongoing trust issues with your physician.

Feeding the issue is the mechanistic, factory style many practices have been forced to adopt. See a PA, get an MRI, treat the MRI finding, see the physician briefly, schedule surgery, rinse and repeat. It amazes me that you tolerate that.

We live within a high-tech, low-touch healthcare environment. Volume = livelihood. Surgery = more money. That is theoretically starting to change with a focus on value, but the upsides of that transition are far off and mostly unpredictable at this time.

What is a patient to do? If something doesn’t sound right — it might not be. Or, it might be right, but maybe it simply wasn’t explained well enough. Frequently it is you who decides if you need surgery and if you are willing to assume the risks of the surgery when weighed against the potential benefits. You see, the only surgery without risk is the surgery which did not take place.

If you are confused, turn to the online space where you might find your answers. Schedule a second, or even a third opinion if necessary. Achieve clarity and be convinced that you are making the right decision for the right reason. Second guess from a position of strength and foresight … not from behind a rear view mirror.