A Conversation About Second Opinions

A Conversation About Second Opinions

A Lump in the Road column

Dr. Michel Choueiri is an oncologist who trained at MD Anderson and UC San Diego. He’s also the founder of cancerdocs.org, a resource that helps patients get access to second opinions. He’s passionate about establishing standards of treatment for this disease and believes all patients deserve the same excellent care that the privileged few receive at the nation’s largest cancer centers.

Recently, I had the opportunity to talk with him. I heard compassion and intelligence as he described the need for all cancer patients to get a second opinion.

During our conversation, he told me about a phone call he recently had with a guy from Saudi Arabia, a man whose wife didn’t want to talk with him. She had just had a mastectomy but after Dr. Choueiri reviewed her information, he concluded that her mastectomy was unnecessary.

Research shows that a second opinion differs from a first up to 60 percent of the time in cancer diagnosis or treatment. I learned from Dr. Choueiri that almost half of cancer patients do get second opinions, whether or not they tell their doctors, but I was surprised to find out how frequently the diagnosis or course of treatment changes during that process.

Here’s a summary of my interview with Dr. Choueiri.

Q: Who should get a second opinion?

A:  Every single cancer patient with very few exceptions! Some cancers, such as acute leukemia and testicular cancer, are so critical, so time sensitive, that the treatment should be initiated as soon as possible. In those cases, there might not be time to get a second opinion. Once these patients are stabilized, and because these cancers can be cured, they can seek a second opinion to make sure they are not missing out on a life-saving treatment regimen.

But with most other cancers — time is of the essence, of course — but they are generally not so critical that an immediate decision has be made. You have time to get another opinion and make an informed decision about your treatment. Don’t make a knee-jerk reaction — take a moment to gather information, seek additional advice, and then proceed once you feel fully comfortable with your treatment plan.

The only other type of patient who probably does not need a second opinion is someone who is already being cared for at a top facility. In that case, patients can have reasonable confidence that their diagnosis and treatment plans are solid. Caregivers at those facilities have been very carefully vetted and have been deemed to be reliable.

Q: As a doctor, does it bother you when a patient wants a second opinion? Does it hurt your feelings?

A: No. In fact, it takes some of the weight off my shoulders. When patients get a second opinion, a different physician could see the disease from a different angle that I had not envisioned. For me, it’s calming to know that another doctor is weighing in and that the patient’s best interest is being very carefully considered.

Q: Does breast cancer present anything particular that benefits from second opinions?

It seems to me that there’s a rush to mastectomy in breast cancer, when possibly a lumpectomy or other options could have been used. For example, ever since Angelina Jolie underwent a double mastectomy, a record number of women have requested them and had them done. A lot of these women did not need these surgeries. Mastectomies are serious procedures and have physical as well as emotional consequences. It’s regrettable that they happen when they could be avoided.  In cancer cases, we don’t know the exact number of patients who receive the wrong treatment, but different studies have put the number anywhere between 5 and 30 percent. These are high numbers, and getting a second opinion is critical.

Q: When I think about why a patient might not get a second opinion, I wonder if cost comes into it?

A: Of course it does. The physician’s advice is the cheapest part of healthcare. Costs are, in a big part, driven by highly priced medications and hospital admissions. Sparing patients the wrong treatment and, hence, unneeded complications saves both the patient and the system a lot of money. A wrong treatment is costly, as is an unneeded mastectomy. Lymphedema treatment from a mastectomy is not cheap. Besides the procedures and treatments, quality of life issues are at stake. What might seem like an expensive pursuit, like paying a doctor for another opinion, will actually save money in the long run if it avoids an incorrect plan of action. If we look at the system as a whole, making the right decisions in a cost-effective yet efficient way will save healthcare billions of dollars, which could be passed to the patients in the form of lower insurance premiums.

Q:  What kind of patient does not get a second opinion?

A: In my experience, older patients, perhaps those older than 60, tend not to get a second opinion. Also, it has been shown that first-generation patients who are not fluent in English, as well as minorities, seek less second opinions than other patients. Economic status also definitely plays a major role. Sadly, for example, a patient who cannot even afford a bus fare will not be able to afford getting on a plane and checking in a hotel in the proximity of a cancer center. There are a lot of hidden costs that prevent patients from seeking expert care. Black and Hispanic patients are typically more at risk, as are those who are linguistically disenfranchised.

Q: Do you have any advice for people who have just been diagnosed?

A: Yes! I have six specific recommendations:

  • Get a second opinion! It is my strong recommendation, and it could save your life.
  • Don’t panic. Every cancer is different. If a cancer is detected early, survival rates are generally high.
  • Find the National Cancer Institute-designated cancer center nearest you and take advantage of those resources. The treatment specialists there have all been carefully vetted and deemed reliable to treat this disease.
  • Bring an advocate to every appointment, someone who can help you navigate your way through this process.
  • Join cancer forums. It’s a great way to digest information at your own pace in language you can understand.
  • Keep all your medical records, including symptoms and side effects, in one place. It will help doctors treat your disease with confidence.

Note: Breast Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Breast Cancer News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to breast cancer.


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