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WHAT IS A REAL SECOND OPINION!

lp1964's picture
lp1964
Posts: 908
Joined: Jun 2013

When I was diagnosed I got plenty of "second" opinions, but I believe these were not incompletely independent second opinions. I had my oncologist and my radiation oncologist of the same institution, which is good as long as it is just routine chemo. As soon as you have options of different chemo drugs or type of surgeries, it's better to get an independent opinion. The mistake I made that at the beginning of the consultation I let each new surgen know what the previous surgens said, so there was a chance that their opinion was biased and not completely independent.

Real independent opinionmeans not a different doctor from the same institution and don't let each new doctor know what the previous dontor said about your situation. Only the cold facts, scans, lab results.

What do you think?

Laz

 

UncleBuddy
Posts: 711
Joined: Aug 2013

I think you're right. Most of the time doctors will agree with each other if they're from the same group. I think it's a good idea to only give them the test and let them come to their own conclusion. I did have the pulmonary surgeon and oncologist from the same group disagree on whether my brother should have his lung nodules removed now. The surgeon wanted to go in and do it asap but the oncologist wants to do chemo first and revisit that later. My brother's surgery is on hold for now, but I may get a 2nd opinion from a different group. The oncologist's reasons seem sound, but I think another opinion is warranted.

So yes, a different opinion outside of your group/hospital is a good idea. Also, just give them the facts and keep the other doctor's diagnosis to yourself. That's my opinion, for what it's worth.

Lin

Cathleen Mary
Posts: 641
Joined: May 2011

 

Hi Laz, 

So glad that you are feeling well enough to be engaged.  Good for you!  

I worked in a major medical center for 21 years and although I basically would agree with you, two things come to mind.

 When a patient's options went before the ethics consult service, one would often hear a lively debate.

My own care post surgery, deciding treatment, went beofre the tumor board. I attemded this meeting and there were two very different opinions.  

That said, I agree a second opinion outside the treating institution is a good idea.

CM

abrub's picture
abrub
Posts: 1542
Joined: Mar 2010

2 of my 3 consults were at Memorial Sloan Kettering in NYC, and the difference between the oncologist and the oncologic surgeon that I met with was extreme.  The GI onc wanted me to start chemo right away, and proclaimed that I would absolutely be dead in 5 years.  The surgical oncologist wanted to get in, check me out, do debulking and give me IP chemo.  Oh, and by the way, my long term prognosis according to him was great. 

I'd seen the surgeon first, the oncologist told me I'd misheard everything the surgeon said, and that I shoudl schedule my port to start chemo immediately.  I went with the surgical oncologist, and guess what?  6 years later, I'm here and healthy.  I missed the memo that I was supposed to be 6 feet under by now.  The other dr was just wrong. 

So yes, it is possible to get conflicting opinions at the same institution.

However, you do want your second opinions from independent thinkers.

tanstaafl's picture
tanstaafl
Posts: 1013
Joined: Oct 2010

We never did get favorable answers on oncology, chem or rad, so we kept interviewing surgeons for one that w/could.  You give each the cold hard facts, but your presentation of useful information, best opinions and goals are still important to maximize the outcome.  On a challenge, most doctors seemed to aim for average results or standard processes, not true maximium outcomes. So we drove an eclectic multimodal process and researched for better answers at steps that appeared to be stumbling blocks.  

We want thoughtful independent opinons, but we plan to be a factor in the ultimate options.  I would rather prep and grill each tumor board member separately for an hour, than to punt to some faceless committee for 5 or 15 minutes.    Standard oncology would be all done 2 years ago.

Sooker55
Posts: 15
Joined: Aug 2013

I obtained consults from 3 different institutions, one of which was substantially different than the other two. I did share the opinions of others, and I found that my medical practitioners had no problem voicing differences of opinions. Medicine is not an exact science; I guess that is the reason it's called a "practice". One practioner looked over my options and rather than recommend one over the other he said he didn't know what to tell implying the the decision was mine. I not so jokingly told him I wanted my money back.

 

Laz, I so enjoy your posts and your attitude and outlook are shining examples for us all.

ron50's picture
ron50
Posts: 1318
Joined: Nov 2001

If you ask for enough opinions , sooner or later you will hear one you like. I had the opinion of my surgeon. Basically you won't make ,too aggressive ,too many lymph nodes. But he did his level best to get it all. My oncologist ,about a 30% chance to make 5 years. If you get mets ,no chance. But he hammered me for 48 weeks with chemo. My opinion. I don't die from cancer. That's the one I chose. And I got by with a little help from my friends......:) Ron.

lp1964's picture
lp1964
Posts: 908
Joined: Jun 2013

"A real second opinion has to be at a separate cancer hospital. A cancer patient has to do a great deal of research to find out where to get the best treatment available. Not all hospitals and doctors are equal. The first thing a patient has to do is to find out what the protocol is for the particular cancer. You can start by finding the NCCN guidelines. Some cancers have commonly accepted protocols for treatment. Some do not .

The next thing a patient has to do is to research cancer hospitals to find out which hospitals have the best reputation for the particular cancer. You can find ratings of hospitals treating cancer at US News and
World Reports. They rate cancer hospitals on many levels, including survival rates. As an example, there are very few doctors who are experts in neuroendocrine cancer. There is no known cure at this point, so there is no protocol, other than surgery. I first had to find experts and then compare hospitals. Experts in this field are not shy about telling a patient what their real opinion is and will readily contradict a doctor without the same level of expertise.

When I was working in a firm that did medical malpractice, I was shocked to see that the medical community is reluctant, generally, to testify about
accepted community standards in medicine. Doctors do not like to contradict each other. I was also shocked that most patients had not researched doctors or hospitals. One patient had gone to a doctor who had many malpractice suits pending for the same surgery that she had with him. The information was readily available. She had never checked the state's board of medicine information portal .

A real second opinion should occur from an independent expert in the cancer that the patient has at a hospital who is very highly rated."

Laz

 

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