July 19, 2007
Sun-Times News Group

Second Opinions... They Can Ease Your Mind, Maybe Even Save Your Life

BY STEPHANIE FOSNIGHT

Getting a second opinion about a drastic and troubling medical procedure is not a modern idea.

"In ancient Greece, it was common to travel to a temple of Asclepius for a procedure known as incubation, where the god would come in a dream and indicate a cure or a prognosis," said Daniel Garrison, a classics professor at Northwestern University.

Today's patients may not pilgrimage to a temple and wait for a dream, but an uncomfortable diagnosis may send them to a practitioner outside conventional medicine, such as an acupuncturist or chiropractor. Or a concerned patient may well ask his or her doctor for a second opinion from another physician within the medical community. Patients may also find themselves in another waiting room when their family doctors deem a second opinion is necessary, often if the treatment includes a drastic option like surgery.

Whatever path you take to get one, the goal of seeking second opinions is to help both patient and doctor know the selected treatment plan is the best available option, and reasonable physicians should encourage the proper use of second opinions, said family doctor Russell Robertson.

"You don't want to feel you're rushed into making a decision, unless there is very little time, and you want to have confidence in your doctor, especially if it's a life-threatening illness," said Dr. Robertson, head of family medicine at Evanston Northwestern Healthcare.

Garrison said the practice of several doctors conferring about one patient's case is built into the western medical system.

"In the Early Modern period, when the patient was a VIP of some kind, doctors would have consultations with each other and even issue written consilia, or opinions like legal opinions, that became part of the medical literature," said Garrison, an expert in early medical history.

These consilia, however, were deliberately written in Latin so laymen couldn't read them.

"This kind of second opinion was definitely not for the patient to know," Garrison.

Doctor's orders
Bob Georges recently found himself the object of medical interest among several doctors, although this being 2007, he was privy to all of the opinions himself.

The story started when Georges began to experience rectal discomfort and bleeding. He tried treating himself with an over-the-counter hemorrhoid cream, but when the problem persisted he went to his trusted family doctor, who then prescribed a hemorrhoid cream.

"He told me to try the cream and, if that didn't work, to get an opinion from a gastroenterologist," recalled Georges, 62.

That gastroenterologist diagnosed a fistula but sent Georges for another opinion from a surgeon before embarking on a treatment. The surgeon, Jose Velasco, chair of surgery at Rush North Shore Medical Center in Skokie, examined Georges, concluded he didn't have a fistula or hemorrhoids after all, and immediately ordered a biopsy.

"It came back cancerous," said Georges, who then underwent a year of surgery, chemotherapy and radiation for anal-rectal cancer. He is now cancer-free and is looking forward to resuming his normal activities, especially baby-sitting his 2-year-old granddaughter.

"If it wasn't for the complete confidence and faith I have in my family doctor, who really encouraged me to seek another opinion, I might have just waited it out and seen if it got better," he said.

A successful patient-physician relationship is built on trust, said Robertson. That means not only taking suggestions, but also being comfortable enough to question your doctor when you have doubts.

"People are often afraid to ask for a second opinion because they don't want to make the doctor angry by inferring that his or her judgment isn't trusted," Robertson said. "A physician who is truly confident in his or her treatment plan will not feel the least bit threatened if a second opinion is requested. If you get a defensive or hostile response, to me that underscores the validity of the request."

Robertson experienced this himself when his own father requested a second opinion from his ophthalmologist about his macular degeneration. The doctor became very angry at Robertson's father, and it forever damaged their relationship.

"He didn't follow through with subsequent care as a result of that," Robertson said.

Getting educated
Margaret Moore, a 56-year-old Deerfield woman, went to her gynecologist last fall because of pain and heavy menstrual periods. After a short examination, her doctor told her that her uterus had "flipped over onto itself," that it was unlike anything he'd ever seen, and that she needed a hysterectomy.

When Moore, a social worker who's been in the medical field, told the gynecologist that she'd like to learn more before going straight to a hysterectomy, he brushed her concerns aside and told her to get in for surgery. So Moore started talking to her friends, all of whom advised her to go for a second opinion.

She ended up at Rush North Shore's Centre for Women's Health, where her new gynecologist did a more thorough exam, explained his findings, ordered more specific tests and then began to present her with options. When he began to explain that she had a diseased ovary as well as fibroids and began discussing the pros and cons of hysterectomy, Moore told him she'd made up her mind and wanted the drastic surgery.

"I didn't mind getting a hysterectomy if that's what it needs to be," she said. "I just didn't want someone to tell me that's the only option and not tell me why."

A month after her surgery, Moore is feeling great, especially since she's now minus the 16 pounds she'd gained from cysts and fibroids. She's also composing a letter she hopes will gently criticize the first practice so as to help other women.

Patients more involved
Surgical oncologist Tina J. Hieken is accustomed to having her patients ask for second opinions, especially breast cancer patients who must choose between mastectomies and breast-conserving surgeries.

"One of the biggest shifts in medicine over the last couple of decades is we put more onus on patients to make decisions about things," said Dr. Hieken, of Rush North Shore. "We don't hear 'Doctor, what should I do?' quite as much as we used to."

So when Hieken's patients come into her office with paperwork they've printed off the Internet or with a request to see another doctor, she tries to accommodate them and help them make the best choice possible.

"Mastectomy versus breast-conserving surgery is the patient's personal decision, and if I think one would be better than the other from a medial or recuperative standpoint, I tell her what I think and why," Hieken said. "Sometimes patients just need to be told, 'Yes, I agree with what your doctor recommended."

Second opinions, then, can increase a patient's confidence in a treatment plan, can bring about a correct or more complete diagnosis, and can provide more options when it comes to selecting a treatment.

However, they can also increase the patient's confusion if everyone, including friends and families, are advocating another course of action.

"I think it's important that, if we give multiple opinions, we have to think about what's in the patient's best interest," Hieken said.

Robertson is happy to go over Internet research with his patients or suggest other doctors they can see, but he said that in the end, he won't always say what they want to hear. Yet it's important to have the chance to ask questions and gather as many opinions as possible.

"I want you to believe you did everything you could under the circumstances with the information you had, so if the outcome turns out to be not what you hoped for, at least you're not wishing you'd done it differently," he said. "That kind of second guessing weighs very heavily on people."