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Does Everyone Need a Second Opinion?
Ernest H Rosenbaum, MD

When a person comes in for their initial consultation, they bring a multitude of problems. Usually they come for a diagnostic work up after they have already been given a diagnosis of cancer. They arrive at an oncology office in a state of alarm and fear. They also have grave questions about their future life.

The first problem I find is the way in which they were given the diagnosis. Usually, it is through a follow-up call after a biopsy and/or test to tell them that they have cancer. Receiving the diagnosis produces a strong emotional reaction. Most people are shocked and devastated, needing more time to fully comprehend the meaning of cancer.

Most cases are usually straightforward. A diagnosis is made and treatments are initiated. Thus, many patients may not need a second opinion. But when a diagnosis of cancer is made, there is much fear, misunderstanding, and many questions about therapy. All these factors can determine whether a person may live or die -- thus it is not unreasonable to a patient to want to have another point of view -- what we call a second opinion.

After analyzing the cancer data, the most important thing a physician can give to a concerned patient or family is to explain, in simple terms, all the pertinent issues. Patients wish for state of the art medical care, but they may have doubts about what is the best way to proceed. Although this is when a second opinion can be very helpful, most patients are reluctant to offend their primary physician by doing so. Many patients do not realize that getting a second opinion is standard practice.

Unless emergency treatment is needed, I feel it is very important for the patient and their family/friends to allow themselves time to learn exactly what the diagnosis means. They need to gather information on how it can be treated (surgery, radiation, or chemotherapy), weigh the options (such as watchful waiting a few months for a less aggressive process vs. immediate treatment in the next few days), and understand the prognosis and the chances for a cure.

Most patients are now better informed -- often having gathered information gathered from the Web, (Internet or PDQ Physician Data Query/CancerNet), newspapers, magazines or from their well-meaning friends. This information is often very mixed and confusing.

It often takes time and several explanations going over the same questions for an anxious and fearful patient to understand and be satisfied with the medical recommendations. Often there are several approaches to a problem and sometimes there is no definitive answer, given the limitations of current medical science.

To help patients make proper decisions; I make a point of informing them and their family/friends at the initial visit that I have two rules in my practice (included on the tape recording that I do for all my consultations). If they are coming for a second opinion, I clarify that they will continue their care with their primary oncologist.

- Rule 1. If I am uncertain or have any questions on the diagnosis or treatment, I will advise them that I would like them to get a second opinion. I state that I would be glad to recommend the person and place which I think would offer the most beneficial consultation to add additional information on how to proceed with their oncology evaluation or therapy

- Rule 2. If at any time they wish to seek a second opinion, as is their right, I would be glad to provide my records, test results, x-rays and pathology report to whomever they wish. If they would like me to select and help arrange a second opinion consultant, I would be available to do so.

I can recall a case where mine was the 9th opinion. This reflects how it may take multiple discussion with your doctor or with another independent unbiased physician to arrive at a conclusion that can give you peace of mind and satisfaction about which is the appropriate therapy.

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

Second Opinions: A Valuable Part of Supportive Care
Multidisciplinary Second Opinion Fundamentals
Cancer Second Opinions Upon Recurrence

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