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Second Opinions 101

What To Do If There Are Conflicting Medical Opinions

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A second opinion that disagrees with the first opinion you receive does not necessarily indicate that one of the doctors is wrong. It simply means they have conflicting opinions.

The field of medicine is not an exact science, and therefore allows for a reasonable difference of opinion. Likewise, there are many times when more than one approach may be effective. The question is which approach works best for your individual lifestyle.

Do not accept the second one just because it is the last one you received or try to decide on your own which is right. So, what should you do when there is even a minimal difference of opinion about your diagnosis and/or recommended treatment? The following steps are recommended:

Step 1. Ask each doctor for their reasoning and source of their advice. Then ask that it be put in writing.

Understanding each doctor's reasoning for his or her recommendation will assist with your evaluation.

  • Is the recommendation based on the latest scientific evidence? If so, on what evidence?
  • Is it based on the doctor's personal experience? If so, what has that experience been? Over how many years? With how many patients?
  • Keep in mind that a doctor's background can have a direct bearing on his recommendation. For example, a surgeon is likely to think primarily in terms of surgical treatments. A research scientist may be most interested in his scientific outcomes.

To assist you in comparing advice from different doctors, ask each doctor to put his or her recommendation in writing, including the pros and cons of the suggested treatment. (An added benefit is that putting tings in writing forces people to hone their thinking).

When comparing opinions, consider the doctor's financial incentives. While money is not the be and end all for most doctors, it may be important to some doctors who are more likely to recommend a specific procedure or treatment if they have something to gain. For example, if you have "indemnity" ("fee-for-service") health insurance, a doctor may recommend a more expensive procedure or treatment, even though a less expensive procedure might be just as beneficial. On the other hand, insurance companies often reward "managed care" plan doctors for recommending a less expensive treatment - even when a costlier treatment may be more beneficial.

Step 2. Show each doctor the other's recommendation and ask questions

Ask each doctor the following question about the other doctor's opinion:

  • What are the points of agreement?
  • What are the points of disagreement?
  • Is there a flaw or weakness in reasoning that may not have occurred to you, or the other doctor?
  • Would another test or exam help clarify the situation?

Step 3. Ask that the two doctors speak directly with each other to discuss your situation and their differences of opinion. (Participate if you want to.)

Sometimes, "two heads are better than one." By working together the doctors may provide each another with valuable insight into your condition or treatment.

If you wish to take part in the discussion, ask the doctors if they have any objections. Many phones can set up a three way telephone conference. If no such phone is available, you can set up a free telephone conference at offsite link (each caller pays for his or her own long distance charges)

Step 4. If necessary, seek a third (or even fourth) opinion.

If after receiving a second opinion you are still unable to make a decision, or if the opinions or recommendations of the two doctors vary greatly, consider taking the time to seek a third (or even fourth) opinion. 

If you would feel more comforatble, enlist the help of someone with general medical knowledge who is not a specialist in the area. The person should be someone with whom you can discuss all youve learned, your concerns, and what's important to you. A good candidate is your primary care physician because:

  • He or she isn't a specialist, so there is no competition with any of the other doctors.
  • There is less likelihood of a pre-formed opinion based on the doctor's schooling or experience in the specialty.
  • The primary care doctor knows you and your life, perhaps even your values.

Also consider speaking with informed friends. Each discussion will help you think of questions, and a different perspective of the risks and benefits of any proposed course of action.

Keep in mind that the final decision is yours - even if you decide that you want someone else to decide. Don't stop until you are satisfied that you understand the situation and are making the best available choice -- one that makes sense to you. If you find yourself looking for a third, fourth, or fifth opinion, consider whether you really need more opinions. Are you really looking for a doctor who will agree with your idea of what you have and what should be done about it? Are you running away from the truth? You'll know the answer when you stop to think about it.

The process of coming to a decision can be difficult emotionally. There are time tested techniques to use to make the wait easier. For instance, keep yourself busy. Access your support system. Exercise.  (For information about dealing with emotions, click here.)

When you are ready, schedule a follow-up appointment with the doctor with whom you want to move forward.

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