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Multidisciplinary Second Opinion Fundamentals
Richard Bloch and Annette Bloch

Doctors other than oncologists diagnose most cancers. They are diagnosed by family doctors, gynecologists, ear-nose-and-throat doctors, and so on. Some of these doctors do not encourage their patients to seek second opinions. These doctors may be afraid of losing revenue, threatened by having their patient believe some other doctor is more knowledgeable, or just do not want to bother consulting with other physicians. The patients of these doctors probably are most in need of the second opinion.

The critical element in successfully treating cancer is in promptly receiving the proper treatment. We know that cancer comes in a hundred different varieties. There is no relationship between breast cancer and brain cancer other than the term cancer and the fact that they are both involve rapidly dividing cells. It is impossible for one primary physician to be informed on the latest and best treatment for every type of cancer. Furthermore, it is impossible for one specialist, such as a surgeon, radiotherapist or oncologist, to know the very latest and best treatment in his own specialty for every one of the more than one hundred different types of cancer.

At lunch with a medical oncologist, I asked how often he treated a patient for cancer without a second opinion. This man, in his sixties, replied that he had never in his career treated a cancer patient without a second opinion. Furthermore, he always insisted on a second opinion from someone other than an associate of his. This was the rationale:

1. Cancer is a very serious disease that grows exponentially. If it is not diagnosed properly the first time, there is often no second chance.

2. The doctor is human and could make a mistake.

3. Someone else could see something that one doctor doesn't see.

4. Someone else could know something that one doctor doesn't know.

I thought this was a profound statement. I wished that every doctor treating a cancer patient could hear this. My conclusion from this statement is that any doctor treating a cancer patient without a second opinion is not practicing medicine, but trying to play God. I thought it was only God, who was supposed to be perfect, know everything and never make a mistake.

These thoughts were substantiated in the draft of the May, 1985 publication of the National Institutes of Health entitled cancer control Objectives for the National 1985-2000. It states, "The application of the state of the art treatment is complex. At all levels of the health service deliver system-from the primary care physician who has initial contact with the patient to specialists directing the cancer treatment-physician knowledge is not yet optimal. That knowledge should include an appreciation for state-of-the-art treatment information and an interest in ensuring early multidisciplinary decision-making. For about 70 percent of cancers, optimal therapy derives from multidisciplinary discussions. The relative rarity of some of the most responsive tumors means that proficient treatment can be maintained only at some major cancer centers. Malpractice considerations may result in physicians selecting safe therapy, which neither offers significant risk nor the chance of cure. A major determinant of outcome for most newly diagnosed cancer patients with curable disease hinges on early multi-disciplinary treatment planning and the availability of expertise and resources to carry out such a treatment plan."

A multi-disciplinary panel is an excellent way to obtain other opinions as well as advice for treatment planning. The purpose of the panel is to review the referring doctor's proposed treatment and approve it or recommend additions or alternatives. The recommendations of the panel are discussed in front of the patient. The panel's comments are written down for the patient and a copy is sent to the referring doctor.

This idea of holding all discussions openly and frankly in front of the patient and any relatives or friends she/he cares to bring is unique in the medical world. Not only do a majority of patients leave with a recommended course of medical treatment, but every patient also leaves with an improved state of mind. They all feel better more confident about what is lies ahead.

Following are points of view about second opinions as a part of the supportive care process.

Does Everyone Need a Second Opinion?
Second Opinions: A Valuable Part of Supportive Care
Cancer Second Opinions Upon Recurrence

R.A. Bloch Cancer Foundation, Inc.

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