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Reasons to Get a Second Opinion!!

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The Value of Second Opinion

People make mistakes every day, and doctors are not immune to this fact. What’s more, some doctors are more conservative while others tend to be more aggressive. So their findings and recommendations can vary dramatically. For this reason, more and more patients are getting second opinions after a diagnosis. Whether your doctor recommends surgery, makes a cancer diagnosis or identifies a rare disease, there are many benefits to getting a second opinion. These benefits include everything from the peace of mind and confirmation to a new diagnosis or a different treatment plan.

Even if your second opinion just confirms what you already know, it can still be beneficial. Afterward, you will know that you have done everything you can to ensure that you have the correct diagnosis and a treatment plan that feels right to you. A second opinion also can offer insight into additional treatment options that the first doctor may not have mentioned. As a result, you become more informed about what is available to you and can make an educated decision about your healthcare and your treatment plan.

What Does Research Say About Second Opinions?

A study conducted by the Mayo Clinic found that as many as 88 percent of patients looking for a second opinion will leave the office with a new or refined diagnosis. Meanwhile, 21 percent of the people will leave with a “distinctly different” diagnosis. Conversely, the study, which was published in the Journal of Evaluation in Clinical Practice, discovered that 12 percent of patients will learn that the original diagnosis was correct. This means that one out of every five patients they saw was incorrectly diagnosed.

During the study, researchers reviewed records of 286 patients referred from primary care physicians to Mayo Clinic’s General Internal Medicine Division in Rochester. The study took place from the beginning of 2009 to the end of 2010. The factors that motivated people to get second opinions included getting confirmation of their diagnosis, being dissatisfied with a consultation, wanting more information, and dealing with persistent symptoms.

Why should you get a Second Opinion?

  • If you have a bit serious or life-threatening disease.
  • Where the treatment is little risky or toxic.
  • Where the treatment is expensive.
  • Where the diagnosis is not clear, the treatment is experimental.
  • If you’re considering participating in a trial for a new drug.


When Should You Get a Second Opinion?

While you do not need a reason to get a second opinion, there are times when getting a second opinion may be the best course of action. What’s more, if the two doctors you see vastly disagree, then it might be wise to get a third opinion. Keep in mind, too, that the second opinion is not necessarily the right opinion. The key is to keep digging until the diagnosis and treatment make sense to you:

Get a second opinion if you have undergone treatment but your symptoms continue. No one knows your body better than you do. And if your symptoms are persistent even after treatment, it may be time to seek the advice of different doctors and specialists. Too often, people do not advocate for themselves. Instead, they assume that they will always have to live with chronic pain or uncomfortable feelings. But remember, the only way you are going to get the treatment that works is if you get the right diagnosis. So if you are not feeling better and your symptoms are not going away, do not settle for that. Reach out to other doctors for their opinions.

Get a second opinion if you are diagnosed with a rare disease. Sometimes diseases are so rare that there is very little research behind them. When this happens, it can be frustrating and frightening to discover you have been diagnosed with something so rare. But you are not alone. Approximately 1 in 10 Americans is diagnosed with a rare disease. What’s more, there are nearly 7,000 known rare disorders with more discovered each year according to the National Organization for Rare Disorders. Because there is so little information available regarding rare diseases and disorders, it is important to do your research, because the risk of misdiagnosis is significant. Look for doctors and specialists who have treated your disorder and get their opinion. You want to be sure you are getting the best treatment possible for your condition.

Get a second opinion if the recommended treatment is risky, involves surgery, is invasive or has lifelong consequences. It is never wise to agree to surgery or another invasive procedure without exploring your options. Yet, some people feel that if a doctor suggests a procedure, they have to agree to it. But remember it is your body and your life. You absolutely have a say in what treatments you agree to. As a result, it may be wise to get a second opinion if your doctor is recommending something as serious as surgery. Being proactive and gathering more information will give you a greater degree of control over your treatment in the end.

Get a second opinion if you are diagnosed with cancer. With something as serious as cancer, having the input from another expert simply makes sense. Not only can a cancer diagnosis be confusing and overwhelming, but it also is a life-changing event. Therefore, it is important to be as informed as possible about your prognosis and the possible treatment options available to you. Keep in mind that no one doctor is completely informed about the findings from every single study and clinical trial in the country. Doctors are only human. That’s why you need to advocate for yourself. Getting additional opinions just improves the likelihood that you will walk away with the best treatment plan possible, What’s more, some insurance providers require a second opinion when it comes to a cancer diagnosis.

Get a second opinion if your gut reaction tells you something is off. By all means, if you are not comfortable with the diagnosis or the recommended treatment, get a second opinion. You should never agree to a procedure or treatment plan when you don’t feel good about it. Trust your gut and gather more information. Ask questions about your prescriptions. Talk to friends. Meet with a new doctor. And read about your condition. No one should ever feel like they have to follow the doctor’s orders without asking questions and gathering more information. Very few healthcare decisions have to be made on the spot. So if something doesn’t feel right, then, by all means, research your situation and talk with another doctor.

Conclusion

Remember, you are not being difficult nor are you in denial about your situation when you ask for a second opinion. You are being smart and empowered. You should always take an active part in your health care, and getting a second opinion is an important part of that process. What’s more, most doctors expect and encourage second opinions. So, be upfront with your physician about your desire to gather more information. And if he doesn’t support you or gives you a difficult time, it might be time for a new doctor.

Source: https://www.verywellhealth.com/top-reasons-to-get-a-second-opinion-4144734

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One surgeon says you need an operation. Another says you don’t. Here’s why that happens!!

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In 2002, when Tim Copeland was just 12 years old, he started having seizures and difficulty speaking. His physician in San Diego couldn’t figure out what the problem was. When Copeland eventually went to see a neurosurgeon in Escondido, California, he was diagnosed with cerebral cavernous malformation, a disorder of the blood vessels that causes them to leak into the brain.

The surgeon told Copeland that his brain was inoperable and the best option was radiation therapy to slow the bleeding.

But Copeland’s mother wanted a Second Opinion. So the family flew to Rochester, Minnesota, to seek advice from a surgeon at the Mayo Clinic.

The Mayo doctor recommended surgery as soon as possible to cut the problematic lesion out of Copeland’s brain.

Within weeks, the boy was on an operating table. Now 26, and a research associate at University of California San Francisco, he hasn’t had a seizure since.

After the operation, the neurosurgeon told Copeland the uptick in symptoms was due to an increase in the severity and frequency of the hemorrhage in his brain.

“I was very lucky that my mom had a bad feeling about my diagnosis,” Copeland added.

Copeland’s story is probably a familiar one. Many Americans get radically diverging opinions from surgeons on the question of whether to operate. These contradictory viewpoints can be a source of great stress and confusion, leaving patients unsure about what to do in what are often life-or-death situations.

There’s plenty of guidance out there for surgeons, so why is this so common?

A new study, published in the Annals of Surgery, tried to get to the bottom of that question. The authors found it all seems to come down to how different surgeons perceive risk — a reminder of how terrible humans are at risk perception, even highly skilled surgeons.

For the research, led by Greg Sacks, a surgical resident at the University of California Los Angeles, a national sample of more than 750 surgeons was presented with four detailed clinical vignettes, asking the doctors to judge the risks and benefits of both operating and not operating in cases that could go either way.

When faced with identical scenarios, the surgeons came up with vastly different estimates for the potential harms and advantages of surgery or nonsurgical management of the disease.

In three of the four cases, surgeons were nearly split on the decision of whether to cut. One vignette, for example, involved the question of an appendicitis on an otherwise healthy 19-year-old with fevers and pain in her right lower abdomen. Here, 49 percent of respondents suggested surgery while 51 percent recommended against it.

In another vignette — involving a 68-year-old patient with a blockage in the small bowel — there was more agreement: 84 percent thought surgery was a good idea. Still, 15 percent of the doctors thought the harms of the surgery outweighed the benefits, once again displaying the variability in surgical decision-making.

This variation seemed to come down to surgeons’ perceptions of risks and benefits, the researchers wrote: “Surgeons were less likely to operate as their perceptions of operative risk increased and their perceptions of nonoperative benefit increased.”

And those risk perceptions were very predictive of whether or not a surgeon would recommend an operation: “Surgeons were more likely to operate as their perceptions of operative benefit increased and their perceptions of nonoperative risk increased.”

But the surgeons differed by as much as 0 to 100 percent when it came to estimating the risks of a surgery, such as the chances a patient might experience a serious complication.

“The truth is that most of the surgeons in their sample are quite experienced, and yet have wildly different assessments of risks and benefits among similar patients,” said Ashish Jha, a Harvard professor of health policy.

Jha, whose research focuses on improving the quality of health care, called the findings “disturbing” and “enormously important.” They should remind us, he said, of how difficult it is for people to evaluate risk, how bad we all are at it, and “how even surgeons are not able to escape these deeply human deficiencies.”

Another implication of this research, Sacks said, is that individual surgeons may be communicating very different risks and benefits to their patients when talking about a potential operation.

Patients need more accurate information about the risks and benefits of surgery

This new research should also remind us of how varied individual surgeons’ advice can be — and that we need to develop better tools to reduce that variation.

One possibility is using a risk calculator, like this one developed by the American College of Surgeons: It takes high-quality data from millions of patients around the country who have had similar operations and uses variables — such as how sick a patient is and the patient’s age — to come up with estimates on the risks of surgery.

In another study, Sacks found that surgeons who used the tool made more accurate predictions and were less varied in their judgments compared with those who didn’t rely on data. In the end, however, the tool didn’t change their decision on whether to operate.

“Although the size of the effect of the risk calculator is modest,” Jha said, “it reminds us that surgeons are trying their best based on limited information — their own experience.”

Tools that provide data like the risk calculator — can help doctors make better choices, or, at the very least, better inform patients of risks and benefits.

“It’s clear we need to develop more resources like this to be additional input beyond personal experience for surgical decision-making,” Jha said.

Copeland, who had the brain surgery that saved his life, would like to do just that. His experience led him to pursue a PhD in epidemiology, and he wants to figure out how to bring decision support systems and evidence-based medicine into consultations with surgeons.

“[These can] supersede the personal biases and subjectivity of physicians,” he explained. “They’re highly skilled at interpreting and practicing medicine — but that leaves a lot of room for error. We can’t expect them to be encyclopedias.”

Source: https://www.vox.com/2016/5/19/11691622/surgery-second-opinion-research-jama

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Second Opinion Leads to Less Invasive Surgery!!

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Nineteen years ago, I had a laminectomy, a major spine operation that removes a portion of the vertebral bone. I didn’t have any problems until this past year when I started experiencing intense back pain that would radiate down my legs all the way to my ankles. I tried taking over-the-counter pain relievers and tried exercises I learned in physical therapy, but nothing was helping. On top of that, my job is very physical; I’m often standing or walking for long periods of time which would aggravate the pain.

Eventually, I went to see my primary care physician who put me in contact with the same surgeon who performed my laminectomy. He recommended that I undergo another laminectomy and a discectomy, removal of abnormal disc material that presses on a nerve root or the spinal cord.

I wasn’t too excited when I heard this, so I wanted to have a Second Opinion to make sure my diagnosis was accurate and to confirm that surgery was the best way to proceed. Fortunately, my Ohio Laborers Benefits offers Grand Rounds as a benefit to its employees. It was exactly what I was looking for.

I reached out to Grand Rounds for a Second Opinion and was matched with Dr. Eric Elowitz, a top neurological surgeon at Weill Cornell Medicine. Dr. Elowitz reviewed all of my records and wrote up an opinion on my case that answered every question I had. The opinion explained my condition in great detail. And while it did not change my course of care, the expert did recommend moving forward with a less invasive surgery.

“After reviewing Dave’s records, I felt that if surgery was needed, I would favor just a microdiscectomy. The reason for this is that a laminectomy is a more extensive surgery and was not needed in Dave’s case. A microdiscectomy is a common procedure which can be performed in a minimally invasive fashion. The procedure usually takes about 40 minutes, and patients go home within a few hours,” said Dr. Elowitz.

Overall, while the opinion did not dramatically change my course of care, I was able to move forward with a less invasive procedure based on my Expert Opinion. Just knowing that the procedure I was going to move forward with was appropriate gave me peace of mind.

Source: https://grandrounds.com/patient/successes/

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INDIA: A Second Opinion!!

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“Over the years, I’ve covered a lot of territory for The Washington Post, but it’s a book project that brings me to India, a book on how other countries deliver health care,” says veteran reporter T.R. Reid, as he begins his FRONTLINE/World report on Ayurveda, a form of medicine that has been practiced in India for three thousand years.

The 60-something Reid also has a personal stake in the matter — a bum shoulder that has been bothering him for 25 years since he injured it in an accident in the Navy.

Reid, who is also known for his humorous commentaries on National Public Radio, travels to the Arya Vaidya Pharmacy, or AVP, in Coimbatore in southern India to see if he can alleviate his aches and pains and avoid the high-tech shoulder surgery that his physician back home in Denver has recommended.

“On first impression, this place looks more like a spa than a hospital,” says Reid as he strolls around the AVP garden, “but I’ve heard the doctors here know their stuff, especially on chronic illness — you know, migraines, back pain, arthritis — the kind of ailments that we in the West can’t seem to fix.”

“This is the failure of Western medicine,” Dr. Ram Manohar, AVP research chief, tells Reid, “because it knows to cure, but it does not know how to heal.”

Reid’s treatment begins with a ceremony at AVP’s temple, where he seeks the blessing of Dhanwantari, the Hindu god of healing. Is this perhaps all part of a placebo effect? Reid wonders. But Dr. Manohar tells him that’s all right: “The placebo effect, I think, is very essential for our medicines to work. Ayurveda believes that healing has to be initiated from the psyche, the mind of the patient. And we use all techniques as much as we can, including religious.”

Next step: Reid meets the chief healer, Medical Director K.G. Raveendran, who consults with him and takes his pulse — at great length — as if he were hearing all the inner disturbances of the body. At last, Dr. Raveendran pronounces his diagnosis: “Pitta, Kapha.”

This pronouncement is based on the ancient Ayurvedic principle that all living things are controlled by three vital forces, or “doshas” — Vata, Pitta, and Kapha. Good health comes from keeping the doshas in balance. As Reid puts it, “When they get out of equilibrium, we get sick. In my case, I have too much Pitta and Kapha, leaving my Vata out of whack.”

What follows is a two-and-a-half-week regimen of oily massages, bitter brews, mudpacks and caustic eye drops. Confiding to his “digital diary” video camera, Reid alternates between skepticism and acceptance as he submits to the treatments — all except the leeches, that is. Those he merely observes at work on another patient.

But can Ayurvedic medicine really cure? Researcher Ram Manohar is prepared to find out. In collaboration with the UCLA Medical School, he’s begun a long-term study to see which works better for rheumatoid arthritis, Ayurveda or the Western drug methotrexate.

“A person like me, I mean, we would like to ultimately understand what really is there in Ayurveda,” says Dr. Manohar. “I mean, we just cannot continue to be mystical about these things. We would really like to demystify the whole process, bring in some transparency, and we feel that if it is found to be not useful, then it will also be a good service.”

At times cranky and sarcastic, Reid nevertheless admits that early mornings at the clinic are magical, and by the end of his stay, he discovers that he has less pain and more movement in his shoulder. The Ayurvedic practitioners tell him to continue the treatments when he returns home to Colorado, and Reid thanks them for their efforts.

Before leaving India, he makes one last stop: Rishikesh, far to the north, the home of the sages, or rishis, and the birthplace of Ayurveda. Pilgrims in the millions come here to perform Hindu rituals in the sacred Ganges, floating candles on the water at night.

Skeptical to begin with, Reid is now convinced that Ayurveda is “on to something,” though it may be hard to prove by Western standards. Perhaps Ram Manohar’s UCLA study will soon provide some answers.

Back home, in a brief epilogue, Reid admits that whatever gains he made in India have faded away. His shoulder is as stiff as ever. “But that’s not the fault of Ayurvedic medicine; let’s be fair here,” says Reid. “It’s because I haven’t done a darned thing about my arm since I left India.” Still, he has decided to skip the surgery that would have implanted a titanium rod in his arm.

“I’m certain that if I did the kind of massage or any kind of exercise like they gave me, even if I took those awful herbal medicines regularly, that my arm would be making significant progress, because we sure did when I was in India,” declares Reid, “and for that I’m grateful to Ayurveda.”

Source: https://www.pbs.org/frontlineworld/stories/india701/video/video_index.html

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Second Opinion Shifts Film School Graduate’s Outlook !!

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As a young girl growing up in Buffalo, New York, Devan Brady’s bedtime story selection was more a survey of American literature than preschool perennials. She remembers her father reading Moby-Dick to her when she was just 3 years old.

“My dad went for the big guns,” Devan says. “The bigger the book, the better.” These adventures unleashed Devan’s imagination. As she grew older, she saw some of her favorite books, such as the Harry Potter series, leap from the page to the big screen. Devan knew there was only one path forward for her: creating magical worlds for kids who love to escape through books and film, just like she did.

But after graduating from college in 2016 with a degree in media production, a medical scare threatened to steal this dream from Devan.

An avid traveler, Devan was on a flight to Japan in January when her legs kept falling asleep, which she knew was common, but the frequency and severity were still puzzling. Several months later in August, Devan was working three part-time jobs: production assistant on a local film crew, wedding photographer and restaurant server. While on her feet for a restaurant shift, Devan felt her legs go numb again. She didn’t regain full sensation for several hours.

Worried, Devan called her local primary care provider, who ran some blood and imaging tests. The results were normal, but her doctor referred Devan to a neurologist for further evaluation.

In the weeks between appointments, Devan didn’t experience any additional episodes and started thinking she was in the clear. After completing a more rigorous set of tests with the neurologist, Devan expected to hear that she had something relatively simple like a pinched nerve. She didn’t expect to leave his office with a diagnosis of the autoimmune disease neuromyelitis optica, more commonly known as NMO.

NMO occurs when the body’s immune system produces a molecule called an antibody that mistakenly targets healthy tissue. Antibodies normally attack targets such as cancer or infection so that the immune system can clear those damaged cells out of the body. But with NMO, these antibodies attach to healthy tissue in the central nervous system, mainly in the optic nerves and spinal cord, but sometimes in the brain, too. As a result, people can experience blindness, weakness or paralysis in the legs or arms, and painful spasms.

An Uncertain Future

“For the whole month of October, I was on edge, nervous,” says Devan. “NMO is a serious disease, and to tell a 22-year-old girl that you could lose your eyesight or use of your legs, that’s scary. What is my life going to be like? I’m going to live in constant fear of losing the ability to do what I love.”

While the neurologist couldn’t confirm the diagnosis through an MRI, Devan tested positive for the NMO antibody in two blood tests, so he prescribed an immune system-suppressing drug to inactivate the circulating antibodies and stop their production, which in turn could prevent further attacks.

A lifetime of taking powerful drugs was just as startling to Devan as the diagnosis. Because her local neurologist had only seen a handful of patients with NMO in the last decade, Devan and her father, a nurse with the Veterans Health Administration, began researching options for a Second Opinion. Through friends and her father’s colleagues, Devan learned about Mayo Clinic’s Department of Neurology and its expertise in NMO.

For at least the last 75 years, what is now known as a spectrum of NMO disorders — sometimes called Devic’s disease — was commonly misdiagnosed as multiple sclerosis (MS). Because MS is treated with medication that boosts immune system action, these therapies could be ineffective and even harmful in the case of NMO. In 2005, physician-scientists and basic researchers at Mayo Clinic discovered a unique antibody specific to NMO. This breakthrough allowed for the development of a diagnostic test, ensuring that NMO patients get the right treatment right away.

“Especially since the test for NMO was created at Mayo Clinic, we thought if anyone would know about this, they would,” Devan says.

Scene Two

Devan and her father made the trip to Rochester, Minnesota, in November and met with neurologists B. Mark Keegan, M.D., and Natalie Parks, M.D., a former Mayo Clinic fellow now at Dalhousie University in Canada. As a provider in Mayo’s Division of Multiple Sclerosis and Autoimmune Neurology, Dr. Keegan regularly sees patients seeking second opinions for diagnoses ranging from multiple sclerosis to NMO and a variety of rare inflammatory diseases affecting the central nervous system.

The team explained that Dr. Parks would do an in-depth examination with Devan and discuss the results with Dr. Keegan. Then, Dr. Keegan would do a second examination.

After comparing their notes on Devan’s medical history and physical tests, Dr. Keegan shared the team’s conclusion.

“He said, ‘If you would have come here after that first day that you had issues and told me your symptoms, I never would have even thought to test for NMO. But because your doctor did, and the result was positive, now we have to deal with it,'” Devan recalls.

The first step was to repeat Devan’s bloodwork, but this time using a much more sophisticated version of the NMO test, which Mayo Clinic has continuously refined over the past decade. If the test came back positive, Dr. Keegan would perform an MRI to look for lesions on her spine. If it came back negative, he would be reasonably confident that Devan did not have NMO. Because getting the blood test results would take a few days, Devan and her father returned to Buffalo to await the news.

A week later, Devan was back at work on a film set when she got a call from Mayo Clinic. It was Dr. Parks with her test results: Devan did not have NMO.

Listening to Dr. Parks explain that the local test results were false positives, Devan started crying tears of relief. She immediately called her father, who interpreted the emotion in Devan’s voice as a bad sign.

“He was like, ‘It’s OK, it’s OK. We’ll book a flight to Rochester.’ And I was saying, ‘No, Dad, the test was negative.’ And I just heard him go, ‘Woo-hoo!’ Like, screaming on the phone.”

Dr. Keegan called a few days later to reassure Devan of the results. In his opinion, Devan’s local neurologist likely relied too heavily on the less sophisticated blood test to make a diagnosis and didn’t factor in the complete picture — Devan’s normal medical history, evaluations and MRI test, plus the fact that Devan’s symptoms were nonspecific to NMO.

Devan has been in good health since then, which she credits to staying active and sticking to her workout routine. She now says her only fear for the future is the same as any post-college graduate’s: finding a job.

But armed with the same boundless imagination that fueled her childhood dreams, she knows the possibilities are limitless.

Source: https://www.mayoclinic.org/giving-to-mayo-clinic/philanthropy-in-action/features-stories/take-two

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