Getting a second opinion can be a sensitive subject for many patients and families to discuss with their doctor. Patients may be reluctant to “question” the authority or skill of their physicians or surgeons. Others are unsure when it is appropriate to ask for a second opinion or if one is actually needed.
- You do not feel comfortable with your doctor or in his/her ability to treat you.
- You do not feel comfortable with the recommended treatment.
- Your treatment options are not clear-cut.
- Your treatment options are only experimental.
- You have been diagnosed with a rare cancer that your physician doesn’t usually treat.
- The facilities where your oncologist practices are less than adequate.
You need a second review of your pathology slides if:
- The pathologist had difficulty interpreting the biopsy specimen, (i.e. such as with lymphoma which can sometimes be difficult to differentiate).
- If the pathologist had difficulty in determining the type of cancer and the report is inconclusive.
- Thank your oncologist for his thoughtful review and inform him that you would feel most comfortable talking with another oncologist, possibly someone who specializes in this tumor type.
- Ask your oncologist who he/she would recommend for a second opinion and why?
- Ask your oncologist for any records, scans, reports, etc. that would be necessary for you to bring with you to the second opinion doctor.
- Reassure your oncologist that you will let him/her know where you choose to have your treatment.
If your oncologist gets upset when you ask for a second opinion, find another oncologist. Your oncologist should not have an ego about your life-saving decisions. Your oncologist should be confident enough in his reputation and recommendations that he both expects and welcomes this request.
It is a fact that many oncologists suggest a second opinion themselves and often times refers patients to specialists who are recognized experts in a certain tumor type.
It is preferable to get a second opinion from a doctor who specializes in your tumor type who is at a different institution from your first oncology opinion. A second opinion should not be a different cancer doctor in the same physician group and in the same hospital as the first doctor. (We don’t like to think that politics, bias or personalities play into such important, life-saving issues, but it happens all of the time.)
- The first people to ask are your oncologist, surgeon or primary care physician.
- Next, talk to your neighbors, relatives, co-workers. Most people know someone who has been touched by this disease and cancer survivors have very definite opinions about their health care teams.
- Seek out the experts, especially if you have a rare cancer or a difficult medical situation.
- Find the major cancer centers nearest to you. Most have a physician referral service that provides consultations for second opinions.
For some insurance carriers, a second opinion may be required before you start your treatments whereas other insurance plans may not cover the fee for a second opinion. Your insurance plan may also restrict your second opinion to a physician that is in-network. So, don’t take a trip across the country unless you know how much of the physician visit will be covered by your insurance. It is prudent to check with your insurance representative prior to coordinating this visit and insist upon complete coverage from your carrier for a second opinion.
Most patients return to the oncologist who completed the initial consult, especially if the second opinion confirmed the first recommendation but the bottom line is the oncologist you should choose is the one you feel most comfortable with. That means being comfortable with the oncologist as well as the treatment recommendation.
It is important to understand the oncologist’s philosophy underpinning the treatment recommendation. After all, oncologists are human beings and may have certain personal or professional biases that influence treatment recommendations. A doctor’s personal experience with a drug regimen may be very different from another’s or a doctor may believe a particular study wasn’t as impressive as the press has reported. Experience and bias are important to understand and play a positive role when exercised by a critically-thinking oncologist.
Your oncologist’s personal philosophy plays the greatest role in cases where patients are facing a terminal diagnosis. For instance, one doctor may recommend hospice care when another feels an aggressive treatment might be worth trying. Neither is right or wrong. What is important in this case is that your philosophy aligns with that of your doctor.
Some patients may have the opportunity to “share” oncologists. If you live in a rural area and travel to and from a large cancer center on a frequent basis is not feasible, there may be another option. Many community oncologists are happy to have a specialty oncologist prescribe and direct the overall plan of treatment while the community oncologist administers the treatment locally. For example: You would travel to the major cancer center once every three months or so for care planning but receive your weekly chemotherapy with the doctor in your area.
What if the second opinion isn’t the same as the first opinion?
When appropriate, oncologists will offer more than one treatment option, and more often than not, the second opinion confirms the treatment options of the first oncologist. However, there are times when there is a clear disagreement between the two opinions. At this point, it will be up to you to continue researching, talking to people and working with NavigateCancer Foundation to weigh the treatment options in relation to your personal philosophies, lifestyle choices and treatment risks. If after your investigation, you give equal weight to each of these opinions, it may be necessary to seek a third opinion.
If there is no clear standard of treatment for you diagnosis, different specialists may be inclined to recommend their treatment above another. For example, if both radiation and surgery are indicated for treatment of prostate cancer, a urologist who specializes in prostate surgery may recommend surgery and a physician who specialized in radiation may recommend radiation. And both may be acceptable forms of treatment. Again, it will be up to you to continue researching, talking to people and working with NavigateCancer Foundation to determine which treatment suits you the best.
Breast Cancer Survivor, North Carolina