Cancer: The value of a second opinion
When facing a life-changing cancer diagnosis, you’re bound to have a lot of questions. First, there are the emotional ones like – What’s going to happen to me? Or how serious is it? And then there are practical matters – Where should I go for treatment? What will I do about insurance?
Before you start mapping out a treatment plan, however, most doctors encourage patients to slow down and take a crucial, but often overlooked step: get a second opinion.
Gone are the days when “the doctor” alone had the authority to make decisions about the treatment of a patient. This means more self-determination for patients. In the case of serious illnesses such as tumours in particular, however, the patient often has to make serious decisions for himself. Then it may make sense to get a second opinion.
“This is especially the case when there is more than one treatment option and the patient feels unsure about the first opinion,” explains Dr. Johannes Rückher, Medical Advisor Certification for the German Cancer Society, in conversation with NetDoktor.de.
Is the risky operation really necessary? Can’t I do without chemotherapy after all? And is there perhaps a completely different alternative for me? Many cancer patients ask themselves such questions. The answers carry weight: “Such a decision can have life-changing consequences,” says the doctor. “Then, when in doubt, it can make sense for someone else to look at it.”
How important is a second opinion?
Second opinions are very important for any patient who has been diagnosed with cancer. The disease is one of the most life-changing events for individuals and their families. People shop around for material items like TVs and cars, so they should do the same for more important issues like general health and cancer. Second opinions are especially crucial for people with aggressive or complex cancers that may require multimodal (different types of) therapy and access to clinical trials.
Even though medicine has made huge advances over the past several years, second opinions are not done as much as they should be. Medicine is still paternalistic and many patients just trust their doctor — for them, whatever their doctor says goes.
Unfortunately, the treating physicians and their hospitals may not follow evidence-based medicine, or there may be a diagnostic error with tumour type or the aggressiveness (grade) of the tumour. Most of the time, the treatment recommendations and treatments themselves are correct, but sometimes they can be incorrect, or there may be other options to which patients are never exposed.
Why and When to Seek a Second Opinion?
If you have been diagnosed with cancer it is crucial that your diagnosis is correct, your treatment plan is appropriate and you are comfortable with the specialists on your cancer care team and what they are recommending.
Even though you may feel an urgency to begin treatment, in most circumstances, you have time to do your research and get additional opinions without negatively impacting the effectiveness of your treatment.
Since it can take up to a few weeks to get a second opinion, confirm with your oncology providers how much time you can delay while you obtain a second opinion. It’s important to recognise that even if you have already started treatment, it’s not too late to get a second opinion. In fact, you can obtain second opinions at any time point during your care (i.e. after your diagnosis, before your treatment, during your treatment, after your treatment.)
It’s not uncommon for treatment plans to change after a patient gets a second opinion. In a University of Michigan study of breast cancer patients, more than half of them changed their treatment after getting a second opinion from a multidisciplinary tumour board of medical oncologists, surgeons, radiation oncologists and pathologists.
Anyone who feels well looked after does not necessarily need a second opinion
“If you feel well looked after with the first opinion, if you have the feeling that all your questions are being answered and that you know all the options, there is no need to get a second opinion,” says the doctor. Nevertheless, the decision could perhaps be so serious that the patient still feels safer with a second opinion.
“Conversely, there are also patients for whom that is too much,” explains Rückher. It also depends very much on the personality how comprehensively informed a patient would like to be. For some, there is more security in being offered a concrete path to follow.
Will I upset or offend my doctor?
You may feel like asking for a second opinion shows a lack of confidence in your doctor’s diagnosis. But most doctors have no trouble with you gathering as much information as you can. Even the American College of Surgeons notes a competent physician should not be insulted when you get a second opinion.
There are many ways to start this conversation with your doctor:
- Ask who they would recommend with special expertise in your condition.
- Ask who they would seek out if they received a similar diagnosis.
- Let your doctor know you want to learn more about your condition before making a decision.
- Ask what other treatments are available and who you could discuss them with.
Finding a second doctor
The first step in gaining a second opinion is to do the research. You can:
- Ask your doctor for a referral, either another doctor’s name or the name of a facility
- Ask your family and friends
- Ask your insurance company or use a tool like Find a Doctor on the apps provided.
- Check the websites of area hospitals
- Research specialty centers
Considering a second opinion?
- Learn about your disease. What it is all about? The severity? The prognosis and options? It’s very important to educate yourself. Understanding the basics and history of the disease, as well as cancer staging, is valuable.
- If your disease is complex or aggressive and you have already been through standard therapies, ask your doctor if there are any clinical trials for which you can be considered.
- Ask if your case will be discussed with other specialists. Cases are reviewed at multidisciplinary tumour boards, with several specialists of different types reviewing a patient’s case.
- Besides learning about your cancer care options, take the time to research your treating physician or physicians and the facility with which they’re associated.
- You have every right to get a second opinion. Be your own advocate.
Will your insurance company pay for a Second Opinion?
Speaking of peace of mind, when talking about medical treatment, the only way to have full peace of mind is to make sure that you do not have to worry about the costs of treatment. Of course, the best way to ensure that such costs are covered is to have a private health insurance plan in place. How do health insurance plans interact with second opinions though?
To be clear here, most health insurance providers will provide coverage for second opinions. This is due to the fact that it oftentimes makes good financial sense for the insurer, in addition to the improved health outcomes for a policyholder that can come with a second opinion. In fact, due to the real benefits inherent to second opinions, some health insurance providers or plans will make obtaining a second opinion mandatory in certain situations. Situations where this will apply mostly involve major surgical procedures or other expensive treatments.
We recognise that decisions about your health and proposed treatments can be the most important you ever have to make, so all members are entitled to a second opinion with all HanseMerkur health insurance plans.
Dubai Health Experience (DXH), the brand conceived by the Dubai Health Authority (DHA), has introduced the Second Medical Opinion (SMO) program to address the needs of patients travelling to the emirate for treatment and provide them with the assistance required for a prompt and effective recovery. The initiative has been designed to relieve pressure placed on those responsible for one’s care and enable them to make the best and most informed decisions regarding treatment options. Requesting a second medical opinion on the dxh.ae website is a simple process, the patient, Insurance provider or the facilitator can sign up and set up an online account. The website allows to submit reports and choose the speciality for which second medical opinion is required.
The DXH SMO program covers seven key specialties: Gynaecology, Orthopaedics, IVF/Fertility related treatments, Cardiology, Neurology, Oncology and Urology.
At the end of the day, you will need to make a final decision based on the different opinions, recommendations, programs, and providers. If the opinions are all very different, it is very unlikely that there is only one right answer and you will have to make the best choice for you based on your circumstances and the information you have.