Second opinions in cancer care

Second opinions can be a blessing or a bane. For anyone going through cancer treatment, thinking carefully about when another opinion may be useful, how to select the right physician, and how to use the information is important. As a general rule, if you are wondering if you ought to find a second opinion, you should proceed. You do not want to look back and wish that you had done so. Here are some suggestions about how to get the most from this appointment:

• Second opinions are most often considered at the time of initial diagnosis and treatment planning or if cancer recurs or progresses. These are moments when difficult decisions must be made and you are trying to identify the best doctors for your situation. "Best" refers here both to knowledge and competence and to the personal/relationship fit.
• Sometimes people become disappointed or dissatisfied with their doctor at some point during cancer treatment. In these situations, it usually makes sense to stay put until the planned treatment has been completed. Once it is done, it is simpler to have a meeting with another physician for another opinion and to consider transferring your care.
• It is reasonable to ask your primary doctor for a referral. Good doctors will never object to your seeking another opinion.
• Do not rely only on the suggestions of well-meaning friends or family. Do your homework to identify the expert you should see.
• Try to meet with a doctor at a different institution or practice than your own. It will feel less awkward and different facilities may have slightly different perspectives and cultures.
• You may choose to travel for this appointment. It is sometimes possible to meet with a specialist at a distant hospital although going regularly for care would be difficult.
• Be aware that insurance rules can make it more difficult. If you have any question about insurance coverage for a second opinion, call your insurance company to inquire.
• Check out your insurance coverage. If your insurance does not cover your preferred consulting doctor, you may choose to pay for a single visit. In that case, avoid having any tests (even bloods); bring your records with you, and be prepared to answer any questions yourself.
• Organize your thoughts and your questions, so you can make the best use of the time.
• Be clear whether you are going for a true second opinion or or are considering moving your care to this person. It may be helpful to share this information with the person who schedules the appointment.
• Chemistry matters a lot. You might opt to work with someone you like less well because of her expertise and team, but you need to feel heard and respected by your caregivers.
• Ask about who you will see at this or subsequent visits. Is it the senior doctor or a fellow or NP? Ask about how to secure a copy of the visit notes and recommendations.
• Take someone with you. It is vital to have a second set of ears and someone to take notes.
• Be prepared for the possibility of hearing something that will complicate your situation. It is reassuring to have a second good doctor confirm the treatment plan, but it is equally distressing to have someone suggest something different.
• In the beginning, all good doctors will recommend the Standard of Care for your situation. No one has any magic. If cancer has progressed, treatment is also the Art of Medicine, not just the Science, and there may be several suggestions of how best to proceed.
• If you do receive a competing opinion, expect to be confused and upset. You will want to go back and discuss this advice with your doctor, and you might choose to have a third tie breaker consultation. Seeing more than three doctors, except in unusual circumstances, is not necessary and very likely to complicate the situation.