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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 2nd doctor agree with the 1st 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 2-3 best treatment options?
What are the 2-3 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:
- 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% 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.
- 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 US - 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.
