Letting Go of the Guilt: Physician Perspective on Second Opinions

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Topics include: Self-Advocacy and Empowerment and Understanding

Patients often struggle with the decision to seek an opinion elsewhere. Is your own doctor’s opinion enough? Will you offend your doctor by getting a second opinion? In this segment, Dr. Brady Stein and Dr. Naveen Pemmaraju, both experts at academic medical centers, weigh in on this important decision.  The doctors share their perspective on second opinions, why it matters with rare conditions, and advice for how to seek consultation with another doctor. 

This town meeting was sponsored by Incyte Corporation. It was produced by Patient Power in partnership with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Audience Member:

So my question is regarding care. So a lot of us started out with community hematologists. And either they didn’t know enough, or we felt like we were mismanaged, misdiagnosed, and then, we end up at academic centers. How do you guys feel about second or third opinions, and at what point is it too many cooks in the kitchen?

Jeff Folloder:     

Thank you for asking that question.

Dr. Pemmaraju: 

I applaud that question. I think it’s great. I encourage it. So I’m going to repeat that. I encourage the second and third opinion.

You may not hear that from every doctor. But I think we all do up here on the stage. The reason I think this is an important point is because these are rare diseases. I mean, we’re talking about a name change in the disease from MPD to MPN. And we’re talking about a spectrum of blood cancers, blood disorders, that a lot of docs may not even see one patient like you, like a person here, in their whole career. That’s how rare these MPNs are. So I think the second and third opinion is important. I encourage it to everyone. Two, I think it’s okay, and I encourage it to do opinions among academic centers. 

Why is that? Because, in a rare disorder where there’s no real major standard of care outside of the few that we’ve discussed here, different centers have different approaches. We’re talking about different clinical trials that are available. But even non-clinical trial approaches, so the information is coming in at a rapid pace. I think it’s important. And then, you have the stylistic, the art of medicine.

This is something that I’m a big believer in and a big fan of, which is not everything is going to follow a cookbook or a recipe, certainly in this space, where there are so few known standard items. So go see different people because, as Brady was mentioning, and as you were, too, I really appreciate this discussion about, actually, you had asked the question I’m on the East Coast, which specialist should I see? There are 30 or 40 of us out there or more. But the key is what kind of a fit and what kind of a communication dialogue can you have? What kind of, over time—because this person is going to be one of the most instrumental people for your overall life and your well-being. 

So I say go for it, do it. Do you have to feel bad about it? No. A lot of the patient experience we’ve begun to notice is a feeling of guilt. And I bring guilty bringing up this problem that I’m missing work, but I’m kind of there, but I’m kind of not. I feel guilty about bringing it up to the doctor I don’t really like this anagrelide (Agrylin) that you prescribed to me. I feel guilty that I’m going to go see Ruben Mesa as a second consult when I’m seeing you.

Don’t feel guilty. It’s your body. It’s your life. And if something doesn’t fit or something is not right, and if your doctor doesn’t agree with the second opinion, maybe it’s time to possibly change doctors, because I think this is an important thing. In 2017, where there’s so much information available and so many different ways of doing things, go out there, and see what’s out there. And don’t be afraid or feel guilty about it.

Dr. Stein:               

I 100 percent agree. I’m not sure I can really say it any better. The idea that—I have patients, it’s typically from the older generation who have gone and gotten a second opinion, they didn’t tell me, or a third opinion. And then, they wrote and said I feel like I’m cheating on you. And you’re not cheating on me. We want you to feel comfortable. We want you to have a second or third opinion. It’s definitely about fit. We also want to know, because we can definitely enhance that experience by sending the doctor records. We can send the right records. When we get second or third opinions, we might get 800 pages of your vital signs. 

But I really need to know your blood counts, your medications, your bone marrow tests, so, we can help put together a packet of your medical—it’s not our bias. It’s your medical chart. So I think it’s important to let your doctor know you’re going to get a second opinion or a third opinion. I don’t think there are really too many cooks in the kitchen. I think that might be more for the patient to decide. And there can be a situation where there can be conflicting opinions. I think that happens a lot in really rare diseases. And I think that happens when it’s really not obvious what the right answer is.

When it’s completely obvious about what we should do, we’re going to agree. When we don’t know, it’s going to be the art of medicine. And we’re going to come at it from a couple of different angles. So, strongly encourage, strongly support. I think better to be up front, as long as you’re comfortable with that, just because we can send the right records. And, that way, the doctor that you’re seeing, it’s going to be a whole lot more efficient if they have the right information.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on September 14, 2017