Second—and Third—Opinions

Let’s assume now that you’ve settled on a doctor and/or surgeon. Does that mean
that whatever he or she says is now the gospel? Hardly. Remember, you’re an in-
formed consumer. And doctors, like all the rest of us, think differently: some are more
aggressive, others more conservative. Thus, you may need a second opinion. Or even
a third.
So now you may worry, “Will I offend this doctor if I say I want a second opinion?”
Do you worry about offending the car dealer when you decide you have a better
deal down the street? This is a mega-bunch more important than a new car. And it
will probably cost more.
You may want to begin by getting a second opin-
ion of the pathologist’s report. You have the right
to the slides and lab reports and can take them (or
have them sent) wherever you wish for another
look-see. (Pathologists may be reluctant to let go of
irreplaceable slides, but keep at it until you find a
mutually agreeable means to the end.) After all,
if the pathologist missed something, or misinter-
preted something, everything else changes.
To check on the general quality of pathology work
in your hospital, call the Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO) at 630-792-5000 or check its Web site at
www.jcaho.org. Ask for the hospital’s inspection
report. The reports have been available to the pub-
lic since 1977.
When?
How do you know if you should get a second opinion? You should probably get a sec-
ond opinion if …
➤ You live in a rural area. Of course you can get excellent treatment at small hos-
pitals, but the medical folks there probably aren’t breast cancer specialists and
the hospital may not have the state-of-the-art equipment a large medical center
will have. It’s better to see the specialists. Ask your hometown doctor for a refer-
ral. He or she will understand.
➤ There’s something “borderline” about your condition. For instance, you hear
a statement like “We don’t usually do chemo in a case like yours, but in this in-
stance, I think we should.” Or you hear the converse, like “We usually do a mas-
tectomy in a case like this, but in your situation, I think we shouldn’t.” Better to
check another opinion.
➤ You’re an HMO member. While you can get superb care through an HMO,
know that historically some HMO doctors have been prohibited from telling
their patients about certain expensive treatments and/or those unavailable
through the local HMO. Public outcry has severely reduced the so-called “gag
rule,” but who knows if and where it still exists. Better to find out, even if you
have to pay for the second opinion yourself.
➤ You’ve been given no hope and told there is no further treatment to help
you. Even if a doctor tells you your condition is inoperable or that the type of
cancer you have is untreatable, get another
opinion. There’s a chance that a different doc-
tor may give a different diagnosis, know of an-
other treatment, or decide that your condition
is, after all, operable. It may save your life.
➤ You have a rare cancer. We’ve talked about the
importance of specialists already, and if you
have a rare cancer, you really need a specialist
in your kind of cancer. If the specialist is across
the continent, then perhaps your doctor can at
least consult with him or her via phone, e-mail,
or fax.
You may have other reasons for seeking a second
opinion, and they are probably valid. The most im-
portant issue is that you’re comfortable that you’ve
had the right diagnosis and the right advice about
treatment. (More on making decisions about treat-
ment in Chapter 5, “Decisions, Decisions, Decisions.”)
Who?
If your condition (physical or emotional) warrants a second (or third) opinion, the
next question, of course, is who do you call? If your doctor recommends someone for
a second opinion, this new person probably works closely with your doctor, maybe
thinks the same way, and perhaps even works in the
same clinic, the same hospital, or with the same group
of specialists. What you really want is an independent
doctor, someone completely independent of your doc-
tor. If you live in a small community, it may mean
you have to go out of town, perhaps to a university or
research hospital.
To decide who to see for your second or third opinion,
first call breast cancer survivor friends and medical
folks for recommendations. For instance, surgical
nurses have insights about surgeons that the rest of us
don’t. Or call a breast cancer hotline, the American
Cancer Society, the National Cancer Institute, the
American Society of Clinical Oncology, or your local
medical society for a referral. (See Appendix E, “Infor-
mational Web Sites.”) Call a hospital of your choice
and request a referral to a breast cancer specialist, or
call a local women’s health center.
After you’ve made enough calls, you’ll start hearing certain names pop up more fre-
quently than dandelions in your lawn. When that happens, you’re on your way to
finding the right person for a second opinion.
After you make the appointment, get going with making your list of questions. And
don’t forget to take your notebook with you to the appointment. It’s wise to take a
friend or objective family member who can help take notes. You might even want to
take a tape recorder. Always ask, but no responsible doctor or surgeon will object to
your recording your consultation. Later, you’ll be relieved that you’re able to replay
the conversation to make sure you didn’t miss or misunderstand something. If your
head is spinning anything like mine was, some details just spin off altogether. But not
with the tape recorder. It just spins back the details, as many times as you want.