You are hardly alone if a significant medical diagnosis has stopped you in your tracks and caused you to wonder whether you should get a second opinion. Christopher McPherson, MD, a neurosurgeon with Mayfield Brain & Spine, has had numerous patients come to him seeking a second opinion. He has also had patients who have sought a second opinion elsewhere. In this post, Dr. McPherson shares his insights on the topic of second opinions and shares his advice on when and whether patients should to seek one.
Q: In your practice, what are the most common scenarios that trigger a request for a second opinion?
A: In general, I believe that patients get second opinions for one of the following reasons:
1) They don’t like the first opinion because it was not what they were expecting. In this situation, they might have been advised that they needed a larger surgery than they expected, such as a spinal fusion.
2) They don’t like — or did not have a good relationship with — the first doctor. I see many patients for second opinions for this reason.
3) They feel like a second opinion is necessary. Many patients either read or hear that a second opinion is something that they should always get.
4) The initial physician suggests they get a second opinion. This can occur in cases of a rare diagnosis or a diagnosis involving complex care.
Q: Do patients seek second opinions more often when the diagnosis relates to a brain issue rather than a spinal issue?
A: I would say that second opinions are more common in cranial conditions. My experience is that when there’s a brain tumor diagnosis, people often travel to other centers to get other opinions. Nevertheless, spinal conditions, which are much more common, still lead to plenty of requests for second opinions.
Q: Under what circumstances would you recommend that a loved one get a second opinion?
A: The most important thing to consider is the relationship with the physician. If you as a patient get a bad vibe from a physician or don’t feel that the physician gave you the appropriate attention you deserve, then I would seek out another physician. It’s also worth considering a second opinion if the physician recommends surgery right away without suggesting nonsurgical treatment options or at least discussing alternative options. This is especially true if the physician is recommending a major surgery.
Q: How do you react when your own patient seeks a second opinion from someone else?
A: I won’t lie. I have feelings, so I do take it personally. That being said, at the end of the day I respect a patient’s right to choose. I have had a few patients who have directly communicated with me their decision to go with a second opinion and their reason for making that decision. Their input was very much appreciated, and I listened to their constructive comments.
Q: Does getting a second opinion compromise a patient’s relationship with his or her initial doctor?
A: Yes and no. Where surgery is concerned, I believe that choosing another surgeon essentially ends the physician-patient relationship with the initial surgeon. Therefore, do not expect that you can continue to do follow-up imaging or get follow-up care with the initial doctor. That relationship is likely terminated. That being said, I have had patients return to me after having had surgery with a surgeon who provided a second opinion. If they return to me for re-evaluation, I am happy to take them back.
Q: What if the two opinions differ dramatically?
A: This is the ultimate danger of second opinions. I have seen many patients who got a second opinion and were left so confused by the conflicting assessments that I have jokingly told them that now they need a third opinion as a tie-breaker. At some point, you have to find a surgeon you trust and go with their opinion.
Q: Are collaborative boards such as Tumor Board and Spine Conference the equivalent of getting a second opinion?
A: In all honesty, these conferences are helpful, but I do not look at them as equivalent to second opinions. I think these conferences are best for patients with complex problems, such as brain tumors or spinal deformities, which benefit from multi-disciplinary management. I don’t really look at these as second opinions because the physicians at these conferences don’t actually meet the patient or have a chance to perform an exam themselves. There is something special you get out of seeing a patient in office and hearing their history and examining them that you cannot get in a conference. In addition, if a patient truly wants a second opinion, then it is best to get one from a true third party and not just another physician in the same group, where there is a tendency to agree with your peers and partners.
Q: Is there any other advice you’d like to share?
A: Patients should strive to get a good first opinion. Find a physician who is well respected, someone you can trust. Ideally, this physician is recommended by people you know. They or a loved one may have been treated by this physician themselves, or perhaps they even work for the physician. If you don’t like something about the first opinion you receive – if, for example, the physician recommends a surgery that is more extensive than what you were expecting – ask the physician directly why that surgery is necessary and why it is the best surgery for you as a patient. This kind of relationship with your physician – an ability to communicate honestly and openly – is essential for optimal care.
Christopher McPherson, MD, is a neurosurgeon with Mayfield Brain & Spine and Director of Neurosurgery at Good Samaritan Hospital in Cincinnati. He has been named to Cincinnati Magazine’s Top Doctors list every year since 2012, and he was named a Health Care Hero finalist by the Cincinnati Business Courier for his brain tumor research in 2013.