Second Opinions

Second opinions – should I or shouldn't I? – have been a major topic of conversation in my office over the past few weeks. The question often comes up shortly after diagnosis when someone is trying to make basic decisions about doctors and hospitals, let alone about treatment. We are blessed in Boston to have an embarrassment of riches, a number of world-class hospitals are a short drive away. I always tell people that the medicine will be the same at any of these fine institutions, but that the air space/culture will feel a bit different. Some people feel more naturally comfortable at one, and others at another. A concrete example: DFCI is the cancer hospital that everyone in New England knows about. Some cancer patients feel safest being cared for at a hospital where everyone and everything is focused on cancer. Other people hate that, and want to be somewhere where there is a broader view and more of life happening.

What matters in these first choices is that you feel comfortable and heard and respected with your doctor(s). Chemistry matters. You may opt to work with someone whom you don't like as well, but feel safest due to her/his reputation and experience. You may like it that a particular doctor works with an NP or a Fellow, so there is at least one other clinician very involved in your care, and you have a second person whom you can call. Or you may not like it at all that the senior doctor is not always the one whom you see.

And, of course, there is the very important piece of insurance coverage. Not everyone has insurance that is accepted everywhere, and it surely behooves you to check this out. You might opt for a single appointment, a second opinion, with someone who is not covered by your plan, but you don't want to get all your care from that person. A reminder: if this is part of your plan, avoid having any tests (even bloods) at the non-insurance-covered office as your costs will skyrocket. Take your records and be well prepared to answer any questions yourself.

The other time that second opinions often are considered is at the point of cancer progression. For most cancers, there is a standard of care that will be followed by any good doctor. If the cancer recurs and/or progresses, it becomes more medicine as art as well as science and there could well be differing opinions on what to do next. This can be upsetting and confusing, but it sometimes is empowering to learn more about the choices.