by Paul Goldfinger, MD, FACC
(Special to the Ocean Grove Record.com)

People understand that getting a second opinion might be a good idea in certain medical situations. The hard part is to know when to request one, who to see, and which opinion to believe.

A patient will visit a physician with the expectation that the doctor will make an accurate diagnosis and recommend the best therapy. Patients want to believe that their doctor knows what to do. This expectation is well founded most of the time, but sometimes the doctor gets it wrong. There are many reasons why a mistake might be made, but suffice it to say, it does happen. Patients need to be wary and inquisitive when it comes to their medical care.

Oftentimes errors are remedied by a system that provides checks, balances, and multiple inputs by nurses, pharmacists, and physician consultants. Correction of errors is more likely in a hospital, where many professionals get to see what is going on, but it is in the office practice of medicine where the risk of unrecognized malpractice is of particular concern.

If something wrong is being done in the care of a patient, obtaining a second opinion by a competent doctor should correct the problem. If you are a patient and you or your family suspect that something untoward is occurring, then you need to request a second opinion. You may not be sure if any errors are being made, but you can recognize when things are not going well or if you sense that the care being given is chaotic or illogical. You may feel uncomfortable asking that another doctor be consulted, but it is your right, so do not be intimidated. A quality doctor will welcome a second opinion.

Sometimes a doctor will suggest a therapeutic plan, such as surgery, which might be an acceptable approach, but you may wonder whether there is a different solution. You should ask for a second opinion, but the fact is that two or more competent doctors can look at the same data and come up with different opinions, all of which are correct. Doctors try to practice “evidence based medicine,” where research guides the physician in the proper care of his patient, but clinical research trials often provide incomplete answers. So doctors must, at times, take care of their patients despite uncertainties, using the information currently available and applying their experience and best judgment.

An example relates to the use of coronary bypass surgery, a treatment that has been available for over 40 years. Despite widespread use of this technique to treat heart disease, there is still controversy about when to recommend the procedure. Consider the results of a poll of 7,632 health professionals by the New England Journal of Medicine regarding the proper care of a 67 year old man with stable heart disease and intermittent chest pains. All the doctors polled were given the same medical data and were asked to choose one of three possible treatment options: bypass surgery, angioplastly/stent procedure (PCI), or medical therapy (drugs, diet, exercise, etc.).

Of the votes cast: 43% favored medical therapy; 40% preferred bypass surgery; and 17% recommended PCI. Based upon our current knowledge, all these doctors were correct. Those who participated were from 111 countries and regions, and 85% were physicians. The rest were medical students or other health professionals.

The Journal concluded that the choice of treatment in this case is “controversial” and that more research is needed. So, this patient could get a second and then a third opinion and wind up with three correct but differing recommendations. What to do?

It is less than ideal, but the patient and his family will have to consider the evidence presented to them and then make a choice. For many in such a situation, the decision boils down to which doctor they trust the most and what is the patient’s preference. When faced with choosing among opinions, the best option may turn out to be the first recommendation, but you won’t know that until you get that second and, perhaps, a third opinion.

Second opinions are used for other reasons in addition to errors or controversy. Sometimes the insurance company will mandate a second opinion before they will pay for surgery. Second opinions may also be requested by the physician himself if he is unsure about his diagnosis or treatment. Other reasons to get a second opinion include: life threatening situations, complex cases, or the suggested use of “off label” medicines or experimental therapies.

When it comes to the choice of a doctor to perform a second opinion, you can ask your physician to suggest someone, but the person chosen must be a doctor who is acknowledged as an expert in your community. If you don’t trust your doctor, then ask another physician whom you might know or a nurse who works at the hospital, or go on the internet to find an expert. (See my article: “Finding a Best Doctor”; request a copy by emailing me at pg1425@optonline.net). One of these approaches should get you someone who has “standing” and whose opinion will be solid. If the situation is serious, and if the circumstances permit, you might want to see a consultant at a major medical center, such as one run by a medical school, even if you must travel to New Brunswick, New York, Philadelphia or elsewhere.

I love the radio commercials by Dr. Mehmet Oz, a cardiac surgeon who is Director of the Cardiovascular Institute at New York Presbyterian Hospital. At that fine hospital, they have a second opinion service for people who were told to undergo heart surgery. He encourages patients to see him because he may find that you don’t need surgery after all. Now that’s my kind of surgeon. You can find consultants like him by calling major centers or by looking at their web sites to inquire about referral services. Physician referral services run by local hospitals are often a waste of time because they give very little information about their doctors and they are not designed to identify the best physicians.

As for this article, if you don’t like it, you can ask Steve Froias, the editor, for a second opinion. He may give you one, but beware, he is not a doctor; he only plays one here on his web site.