Getting a second opinion

Once,  I had a patient who timidly told me that she wanted to seek a second opinion on my recommendation for her to undergo surgery.

I encouraged her to do so, but I was also puzzled as to why she seemed so hesitant to bring up the idea. It turned out that she was worried that I would get angry with her for “doubting” my expertise.

My peers in the medical field have encountered similar situations with their patients, while some of my friends and relatives complain of doctors who brush off their requests to get a second opinion.

In these cases, both physicians and patients are misinformed about the patient’s right to seek different opinions and choices for their treatment. It is this gap in understanding that has lead to some doctors becoming over-confident in their management of patients, and patients losing trust in the healthcare system.

We’ve all experienced this before: we seek the advice of a skilled expert, such as a doctor, or even a mechanic, plumber or lawyer, but we cannot understand their diagnosis or explanation of the problem. Perhaps they are recommending a procedure or treatment that you are unsure about, or even not recommending any solutions at all.

In the clinic or hospital, you may be advised to undergo surgery that you find to be too expensive or carry too many risks.

At times like these, your immediate instinct should be to ask another expert for their opinion. And you would be right to do so.

Medicine is not foolproof, and there is always room for improvement. Therefore, seeking a second opinion benefits a patient as much as it benefits the doctor, because another set of eyes analysing a patient’s history, test results, or symptoms could pick out something that had been missed before.

Not an insult to the doctor

Not an insult

This should not be seen as an insult to the doctor. The practice of medicine and scientific research revolves around peer review, where doctors and scientists value each others’ opinions and provide the check-and-balance necessary for responsible practice.

As science is continuously developing and changing, there are always new and different approaches to managing a condition. There isn’t a doctor who can claim to know them all or be the expert in everything.

Getting a second or third opinion could give you additional information, or help you to look at the situation from a different perspective. You may get more options for treatment and you can use all the information you now have to make a decision.

For women, there are certain diagnoses or issues that are crucial to seek a second opinion. Generally, if your doctor recommends long-term medication that has potential side effects, or if you aren’t getting any better after numerous visits to the doctor, then it is prudent to ask for other advice.

Women should also exercise caution when it comes to gender-specific issues, such as problems with the reproductive system, especially if the doctor recommends hysterectomy. As this surgery requires the removal of the uterus, it should only be considered as a last resort if less invasive treatments like medication do not work.

If your doctor does not offer you the other options, you should seek a second opinion as to whether a hysterectomy is necessary.

Heart disease can also be gender-specific, especially when the cardiac problems are unresolved and symptoms persist. For instance, the signs of a heart attack in women can be very different from those in men, or tests to detect heart disease may be less sensitive to women’s heart problems, so women may be sent home without a proper diagnosis.

If you continue to experience symptoms such as shortness of breath, periods of rapid heartbeat, and unusual weakness and fatigue, but the doctor is unable to identify the cause, you could seek another opinion from a specialist in women’s heart disease.

Cancer is another condition that should be handled with caution and lots of information. A diagnosis of cancer, especially breast or gynaecological cancer for women, is fraught with stress, anxiety, and uncertainty over the person’s future. Decisions about treatment should not be made lightly, especially if aggressive therapy is offered, or if it is suggested to remove the breast or womb as a preventive measure against future cancer.

When it comes to diseases like cancer, there are many cases of women who seek second opinions from alternative or complementary medicine practitioners. While some of these complementary therapies may have their benefits, do remember that they are not likely to have scientific evidence to back them up. Be very cautious about using these alternative opinions in place of conventional, proven medical therapies.

So you have decided that you want to seek a second opinion. Now, how do you find another doctor, and what do you ask?

Getting another opinion

You could start by asking your treating doctor or specialist to recommend someone for you. This is often the biggest hurdle for patients, because they feel embarrassed or awkward as it might be perceived as an insult to the doctor.

However, the doctor treating you should be professional enough to accept and encourage you to seek other opinions from his or her peers. They should recommend someone whom they respect and consider to be a specialist in the field as well.

If asking your doctor doesn’t work out, you can also approach another doctor yourself. If you don’t know any other specialists, try going to your family physician or GP to ask for a referral. You can also go through local medical societies and organisations, or university teaching hospitals, to look for a specialist in a particular field.

When you find another doctor, your current primary care doctor will have to send your medical records over, so that a comprehensive analysis can be made. Some doctors require your written permission in order to release your records.

You should also check with your health insurer if the second opinion visit and any additional tests can be claimed, and whether there are any conditions attached.

When you see the other doctor, be sure to ask all the questions that you had asked your treating doctor before, and any additional questions that you have thought of. Pay attention to the worries and doubts that made you seek a second opinion in the first place, and get answers to those.

A proper second opinion requires a full medical examination and perhaps even additional tests. Talking to the doctor over the telephone does not count as a second consult.

After all this effort, you may find yourself disappointed to find that the second doctor confirms the diagnosis and treatment method of the first doctor. However, second opinions are not always about opposing views, and it should reassure you if two qualified doctors agree on the next best step for you.

If a conflict in opinion does arise, you may be really confused by now! Don’t worry, more information is always a good thing. You can also ask the two doctors to explain their decisions in detail and visit the pros and cons of the different treatments that each one is proposing. You may also want to consider getting a third opinion, if time and finances allow you to.

Ultimately, the question is: who do you listen to? Which opinion do you consider?

At the end of the day, the decision is yours to make, not your doctor’s. The doctor can only be your advisor and guide through this difficult time. Talk to your family about your choices and how it would impact your life.

Be sure to act based on rational information and evidence, not emotions or fears.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). The information provided is for educational and communication purposes only and it should not be construed as personal medical advice.

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