After days of nail-biting, the dreaded diagnosis is out: it’s cancer, your doctor says. As you struggle to digest this life-changing news, he is already telling you about the expensive or newer experimental treatment he has in mind. You quietly ask yourself: Should I seek a second opinion?

It depends. A second opinion would not be necessary if you have a good relationship with your doctor, trust that he has your best interests at heart, knows what he is talking about, and has provided sufficient information for you to make an informed decision on your treatment, said Associate Professor Kenneth Mak, Director of Medical Services at Singapore’s Ministry of Health.

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However, seeking out a second healthcare professional for a second opinion is a good idea, if you think that the first doctor may not be giving you the full picture, he said.

In a situation where you are not satisfied that sufficient information has been provided for you to make a decision, and if your doctor is unable to assure you that he has the necessary competency and proficiency to advise you and treat you, or if you have any doubts that your doctor has motivations which are not aligned with your welfare, then it is reasonable to seek a second opinion.

Trust issues

“It is reasonable to seek a second opinion when you suspect that the information given to you is not completely accurate, or may be biased. This doesn’t happen necessarily because the information is wrong, but because there’s a certain amount of cherry-picking when the info is presented to you,” he told AsiaMD.com via a Zoom interview.

When a specialist recommends a certain treatment by promoting only its pros and failing to mention its cons, patients might question if the doctor has motives other than their best interests. People could wonder if a doctor strongly recommends a certain treatment because he gets certain benefits, or if he stands to receive financial gain from a third party, said A/Prof Mak. “In that setting where you’re not comfortable, the truth is that you’re not able to form a trusted relationship with your doctor,” he said.

Other good reasons to seek a second opinion

Even if your doctor has not done or said anything to warrant doubt, doing your own research may be beneficial for the following reasons:

• You empower yourself by gaining more knowledge of your condition and your options. By becoming a more educated healthcare consumer, you are more equipped to make informed decisions that have long-term consequences on your own health.
• A few studies have shown that it is worthwhile to get additional medical opinions. A 2015 study from Houston Veteran Affairs Center found that seeking a second opinion led to changes in the course of treatment for approximately 37 per cent of patients and changes in diagnosis for 15 per cent.

Changes in diagnoses and treatments from second opinion in 6791 cases. Percentages of patients whose second opinions led to changes, clarifications, or confirmations of diagnoses and of treatments, as assessed by program clinical staff.

Source: The American Journal of Medicine

• A 2017 study showed that 21 per cent of patients who sought a second opinion at the Mayo Clinic left with a completely new diagnosis, and 66 per cent were deemed partly correct, but needed to be refined or redefined by the second doctor.
• Seeking a second opinion is common, and doctors ask their colleagues for their perspectives frequently, especially when cases are complex. Don’t worry about your doctor feeling insulted if you ask for your medical records and pathology slides so that you can consult with someone else.
• Get peace of mind by confirming if the first medical diagnosis and pathological interpretation are accurate, and if the proposed treatment plan is appropriate.
• Newer and investigational medical treatment options may be available. Seeking a second opinion may allow you to better appreciate whether there are alternative treatments available for your condition beyond what had been recommended initially to you. You should be aware that some of these alternative treatments may not be considered standard of care or subsidised in the healthcare financing system in your country. Other treatments may only be provided in the context of clinical trials and investigational studies because the efficacy or side effects of the treatment or its cost effectiveness is not fully known. You should approach these novel treatments with some caution and listen carefully to the advice given by the different doctors you consult. These other treatments may be worth considering when standard treatments are not able to satisfactorily offer a good outcome based on the severity of your condition but you must be prepared to accept the uncertainties associated with the newer treatments.

 

Seek qualified, credible medical professional opinion

After you tell your friends and relatives about your medical condition, stories of how effective some folk remedies are might trickle in. You might read or hear about how traditional remedies and lifestyle changes can cure or reverse your condition, and you might want to explore such alternative therapies instead of medical treatment. However, doing so may come at a grave cost, warns A/Prof Mak.

He shared that he has seen patients who have pursued alternative remedies after doubting a diagnosis of cancer, its severity, and whether or not the recommended medical treatments were correct. By the time they had a change of heart, that cancer had already progressed to an advanced stage, and could not be cured anymore. “So choose your second opinion sources carefully, and choose someone who is credible to give you the appropriate advice,” he said.

If you wish to assess whether a certain lifestyle choice or traditional remedy is suitable for your condition, the answers are not found in alternative therapy circles in social media. It is best to go to a credible healthcare expert in that particular field to get further advice and more information, said A/Prof Mak.

How harmful is fake medical news? Get tips from DMS Kenneth Mak on recognising falsehoods

 

Ask your general practitioner for a specialist referral

Now that you are convinced that you need a second medical opinion, the next question is: Where should you get it from?

In a WebMD interview, Dr Jerome Groopman, author of Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, pointed out that it was important to see someone at an institution different from the first doctor.

“Institutional cultures are real, and often an opinion leader at one hospital will do things a certain way and others at that institution will conform to that viewpoint. But at another hospital, even across town, there may be a very different philosophy,” he said.

A/Prof Mak of Singapore thinks that the best person to ask for a specialist referral is your own general practitioner (GP). Having invested in building a trusted relationship with your family physician over the years will pay off during a time like this. Your GP can be a fount of reliable medical information, and help assess suspect claims and yes, recommend a credible healthcare specialist for your condition.

He said: “Your family physician – the general practitioner – may not be the best expert to tell you about the latest in cancer treatments. But he may be able to recommend a second doctor who may have your best interests at heart. Your GP is an important source of info, and an important navigator for you, as you suss out what are recommendations that are made in your best interests.”

As with combating fake medical news, it pays to be circumspect and well-informed as you weigh your options. Where your health is concerned, it is best not to cut any corners.