What you need to know about second opinions

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A variety of doctors at Upstate care for patients who are diagnosed with cancer.

We tapped some of them to share insights on second opinions.

Here’s what they had to say:

1. You don’t need my permission to get a second opinion. And, don’t worry that you are betraying me or hurting my feelings by asking for one. “I don’t know one physician who would take this personally,” said Srinivas Vourganti, MD, a urologist at Upstate Medical University who advised firing any doctor who did not support a patient who did so.

Srinivas Vourganti, MD

Srinivas Vourganti, MD

2. I can probably suggest two or three doctors you might want to see for a second opinion, and my office staff might even be able to help schedule that appointment.

3. One of my partners can render a helpful second opinion. Just because we work together does not mean we think alike.

4. It may make sense to seek an opinion from a doctor who is not in the same specialty. An orthopedic surgeon may say you need surgery, for instance, while a rheumatologist may recommend physical therapy.

5. Second opinions should be automatic in situations where a doctor proposes an experimental procedure or a treatment that is unproven.

6. Check with your health insurer about coverage, because I have seen policies that won’t pay for second opinions at out-of-state facilities. Also, be prepared for the costs involved in traveling out of the area, since those are usually not reimbursed.

7. If what you really want is a different perspective, see a doctor from a different region of the country, where medical practice styles are likely to differ. Some institutions facilitate electronic second opinions so that patients don’t have to travel.

Robert Dunton, MD

Robert Dunton, MD

8. As your doctor, part of my job is to help you digest the information you find through your own research and decide whether a second opinion makes sense. “People come armed with a lot of information — not all of it good or pertinent,” said Robert Dunton, MD, chief of cardio-thoracic surgery at Upstate University Hospital. “I will tell you if I think you’re making a bad decision, but,” Dunton said, “if a patient picks an inferior choice knowing their options, that’s their prerogative.”

9. We’re in this together. If your gut is telling you to see what another doctor thinks, you are not going to feel right until you do.

10. You may not think you need a second opinion, but I may want you to get one. Perhaps you need surgery and there are different ways to do the operation. Another surgeon’s input could help determine the best approach for your case.

11. Even though they are not in your possession, every note and every slide that pertain to your care belong to you. If you want biopsy tissue to be reviewed, for instance, you can grant permission for it to be released. Just realize that gathering all of your records, particularly if you have seen multiple physicians, is likely to require a lot of your time.

Ajeet Gajra, MD

Ajeet Gajra, MD

12. If you face cancer, enlisting an oncologist may be more important than only obtaining a second opinion. An oncologist can help you manage your disease and your decisions. You’d be surprised how many people who receive a cancer diagnosis go straight to surgery or another treatment without considering the impact. “They get a procedure view, but they don’t get a life view. It’s not cancer management,” said Ajeet Gajra, MD, a medical oncologist at the Upstate Cancer Center.

13. There are instances where you may want a third opinion or tiebreaker. Consider the diagnosis of pectus excavatum, the abnormal development of the rib cage in which the breastbone caves inward. One doctor may recommend no intervention. Another may favor an elaborate insertion of metal bars into the chest. Additional input may help you make a decision.

14. If your second opinion differs considerably from the first, “it’s time to have an honest discussion with your provider,” said Gajra. “People need to understand there can be more than one valid approach.”

15. I would not want to lose you as a patient, but if you prefer the second doctor, I would tell you to get care where you feel most comfortable.

16. You may not need a second opinion. Many patients at the Upstate Cancer Center, particularly those with complex cancers, have their cases presented at a weekly multidisciplinary conference. This is where a variety of cancer and medical specialists discuss your situation and reach a consensus on your best options — so you essentially receive multiple professional opinions. This style of multidisciplinary care is becoming the gold standard.

17. If I’m the doctor providing a second opinion, I’ll do my best to give an unbiased opinion, regardless of whether I agree with the first doctor. If he or she has made mistakes, I’ll find a professional way to let you know.

18. I really do care what’s best for you. I’ll tell you if your condition warrants treatment elsewhere. Some rare conditions are best treated by highly specialized physicians.

Layout 119. I do not want to dampen your hopes, but I will be straight with you. You are probably hoping that another doctor will be able to tell you that you don’t have cancer, or that it is not so advanced, or that he or she has a miracle cure. That almost never happens.

20. Most of the time after a patient gets a second opinion, there is no change in his or her treatment plan. However, they feel as if they are better educated — and that’s a good thing.

This article appears in the summer 2015 issue of Cancer Care magazine.

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