What is a Real Second Opinion?
Why get a second surgical opinion? This is Dr. John Shim, and I want to discuss this very important topic. When you're in a life-and-death situation, there's no time for a second opinion. Time is of the essence. I say thank God you're in the United States because we have the best trained, and most ethical surgeons in the world. The on-call surgeon has a skill set to care for you during those times of crisis. If you need emergent surgery please know that the surgeon on call is the best one to handle your emergency needs. Calling around while time is critical is not beneficial. But when it comes to elective spine related concerns - when folks have a choice, it makes sense to get a second opinion. Why? That's because elective issues often have many options, and different levels of risks associated with the options. Opinions differ on how to treat conditions and issues related to the aging spine. Many spine conditions are related to the wear and tear of life. Many spine conditions do resolve over time or once we accept some level of change, become an acceptable level of annoyance when weighing the risks of some of the procedures. It comes down to the presentation, and a two-way communication between patient and doctor to determine what's best for each situation. A thoughtful discussion will include all the options, the success rates of each option, the potential adverse effects of each option, and the longevity of benefit of each option. A thoughtful discussion will also include a true assessment of the goals of this treatment. Sometimes the patient and the doctor may not have the same goal or the same understanding of the goal. That's why second opinions can be very beneficial to elective problems. Your preference matters, your risk tolerance matters, and your confidence in the opinion matters. Every surgeon also brings their own experience into the discussion. There's been an evolution of spine surgery techniques in the past 30 years. Older surgeons will remember the fads in the past that seemed promising, but did not deliver on the long-term results. Based on these experiences surgeons will make different recommendations. Please understand that different opinions do not mean the other opinion is wrong. There are different ways to achieve similar goals. It's a matter of matching the expectations with the goals with consideration for the risks. It's a matter of knowing the long-term effects of surgical options, and the anticipation of solutions to potential outcome deviations. If you're going to have elective surgery a second opinion can offer other options for your condition. This is Dr. John Shim discussing second surgical opinions. I hope you'll get the information you need to make your decision. Thank you.
You are sitting on an examination table, wearing not much more than a Kleenex, and your physician is telling you that he/ she recommends surgery. You hear that word and everything else sounds like the teacher on Charlie Brown. “Wah, wah, wah, wah”. You’ve only seen this doctor once before and all of a sudden, your life is in their hands. What do you do?
The first thing you do is realize that doctors are all trained differently, may not be aware of other options available, or may not be as comfortable with some treatments as other physicians, and even if you know nothing about medicine, you are your own best advocate. Then you get a copy of your notes, including diagnosis codes and proposed surgical codes and start your homework. This means more than consulting “Dr. Google”. This means calling every medical person you know and getting names. It means calling your insurance company and finding out if second opinions are reimbursed. If they aren’t, it means getting the money together, because this is too important to pinch pennies on.
Some people make an appointment for a second opinion in the same office as the first, or get another name from the original doctor. I feel this is not a true second opinion. If these doctors share an office, or play golf together every Wednesday, they are unlikely to contradict each other. This is where having a friend or acquaintance in the medical community will come in handy. If you don’t have that, look into patient advocacy programs.
One point to consider is if you tell the second opinion that they are, in fact, a second opinion. Many people feel they should go in cold and have the appointment take place as if it were the original one. Another way is to book a second opinion but not to tell the second physician what the first one said. The last way is to tell the second surgeon what the first one said, and ask if they agree with both the diagnosis and treatment recommended.
If the second opinion is not the same as the first, they are not automatically right, just different. More research is called for, until you are convinced you are doing the best thing possible for present circumstances.
All this is moot if you are in an emergency situation, such as pending paralysis or death, but should be considered any other time a major medical recommendation is received. No one is perfect, but you are your own protection against getting an incorrect or incomplete diagnosis, or treatment. Any physician that argues this is suspect, and makes a stronger case for caution.
- Abbasi J. Shantanu Nundy, MD: The Human Diagnosis Project. JAMA. 2018 Jan 23;319(4):329-331. PubMed PMID: 29362789