machado: why are we so scared of asking for a second opinion?
say what you want about a patient's right to another opinion or how offended a doctor gets to be about said opinion, the bottom line is asking questions and getting more information is good for everyone.
6 minute read
asking for a second opinion is an opportunity to reassure patients and boost confidence in their treatment plan.
getty
if allen chankowsky didn’t get a third opinion, he would be dead. after a 2016 diagnosis of salivary duct carcinoma (sdc), an aggressive and rare head and neck cancer, chankowsky, who was familiar with the relentlessness of cancer after surviving hodgkin’s lymphoma in 1991, underwent a radical neck dissection. it was too late though — most of the lymph nodes removed from his neck were cancerous. what came next was a gruelling course of radiation, but soon after, cancer was discovered in his lungs. he was given a 20 per cent chance of surviving five years, and a “management” plan that consisted of using chemotherapy to hold off the spread of the tumours for as long as possible.
it wasn’t any kind of solution when the goal was living, so chankowsky, who had two kids aged 9 and 12 at the time, set out to save his life. and he did. all of his research, discussions with experts, questions and more questions, paid off with the discovery of the achilles heel of his disease — androgens, which his medical team targeted with specific therapy (androgen deprivation therapy), shrinking the tumours to virtually immeasurable. the doctors called his response to the treatment “complete.”
he is alive to tell the tale because he sought different opinions
advertisement
his story is a compelling testament to the value of precision medicine, but also to everything that advocating for yourself can accomplish. from learning about his disease and studying scientific research, to getting the advice of experts across north america and seeking testing outside of his healthcare team, chankowsky is alive to tell the tale because he sought out other opinions. and if you were to ask him today, tomorrow and the next day, what the most important thing someone living with cancer can do to ensure the best outcome, he’d tell you again and again that getting a second opinion — a third or fourth, even — is not only critical to your well-being, it’s also your right. (in fact, it’s included in the canadian medical association’s code of ethics and professionalism which instructs doctors to respect a patient’s reasonable request for a second opinion.) there’s also no limit on the number of second opinions you can request, in case you were wondering.
but going beyond your doctor’s care for advice, information and guidance isn’t an easy thing, especially when you are sick and tired, when [insert scary disease] is breathing hot down your neck, and when you are terrified and painfully aware that the person sitting across from you in the white coat is your best chance at some good news and you are worried about the implications of ticking them off.
advertisement
earlier this year, carp (canadian association of retired persons) did a survey of older canadians asking about their experiences engaging with their medical teams on cancer care and treatment decisions. the results, based on 1200 responses, found that while 78 per cent wanted to be involved in their treatment decisions at all times, 46 per cent were “uncomfortable or unsure about asking for a second medical opinion.”
that’s almost half of those surveyed.
it makes me think about allen and what would have happened if he had been among that 46 per cent and not been relentless in his pursuit of other perspectives of his disease and potential for survival. what the heck is it with us and second opinions? after all, this is our life we’re talking about.
a second opinion can increase the chances of a better outcome
certainly, our reticence to seek the help of another “expert” is not limited to healthcare. for some of us, seeing another hair stylist, dentist or even trying a new sushi place instead of your regular hangout can be harrowingly guilt-inducing. except that in healthcare, your health is not simply an issue of taking too much off the top or a better veneer or cheaper tempura — it’s a matter of life and death, or at the very least, well-being versus even better well-being. in fact, seeking a second opinion can be a very good thing, helping you figure out what treatment option is best, or if there are others that might be available, according to the canadian cancer society. it may also reassure you that the right tests and diagnostics have been done and understood correctly, and help you feel more comfortable about your diagnosis and treatment decisions.
advertisement
and while you don’t need a reason to seek a second opinion, verywellhealth outlines five situations in which getting another doctor’s perspective makes a lot of sense: if you have had treatment, but your symptoms continue; if you are diagnosed with a rare disease; if the recommended treatment is risky, involves surgery, is invasive or has lifelong consequences; if you are diagnosed with cancer; and if your instinct tells you something is off. feeling rushed or ignored, not listened to or judged are other reasons you may want to get another opinion.
all these things are completely logical grounds on which to seek a second opinion, and yet, many patients would rather ignore feelings of unease than be honest and come clean with their doctor. you might feel that seeking a second opinion is offensive and insulting to your doctor, like you’re “cheating,” or sending a message that you don’t trust them or think they are capable or have expertise. you may worry that getting a second opinion may make future interactions with your doctor uncomfortable or tense or be damaging to your relationship. i have also heard patients say that they worry that asking for a second opinion could irritate their doctor to the extent they stop their treatment, or refuse to see them again. but dr. howard evans, a urologic surgeon at the royal alexandra hospital in edmonton and member of the board of directors for the alberta medical association told healthing that the easiest way to disarm and diffuse any awkwardness is to ask your doctor directly whether a second opinion might be worthwhile. and if they aren’t receptive, he suggests throwing in some context with a twist of confidence-boosting to your ask.
advertisement
“say something like, ‘my relative saw dr. x for a similar problem and was very pleased — is there any way i could see him or her for a second opinion?’” he advises. “’i have utmost trust in you, but my relative feels an opinion from him or her would also be helpful.’”
what if your doctor says no?
paul taylor, who was a patient navigation advisor for sunnybrook health sciences centre until 2020, advises in his blog that dialogue becomes super important when a doctor declines a patient’s request for a second opinion. in talking with david jensen, a spokesperson for the ontario ministry of health and sally bean, a medical ethicist and policy advisor at sunnybrook, he suggests beginning the conversation by saying that you feel your request is reasonable and asking why your doctor thinks a second opinion isn’t necessary. if that doesn’t get you anywhere, it may be time for a new doctor, he says. of course, there are always walk-in clinics or an urgent care centre where you can see a doctor without a referral, but taylor notes they won’t have access to your medical records.
there are also some guidelines for doctors when it comes to second opinions. according to the canadian medical protective association (cmpa), while patients have the right to question their physician’s advice and choose to see a different healthcare provider, doctors are advised that it “should not be interpreted as a breakdown in the doctor-patient relationship.” hallelujah. and, if the second physician’s opinion conflicts with theirs, they are under no obligation to provide treatment they feel is not medically indicated, not supported by scientific evidence, or outside their area of competence or experience.
advertisement
of course, say what you want about a patient’s right to another opinion or how offended a doctor gets to be about said opinion, the bottom line is asking questions and getting more information is good for everyone — it’s an opportunity to increase knowledge and validate decisions, reassure patients and also boost confidence in their treatment plan. most importantly, it increases the odds that the chosen treatment path is the most appropriate, effective and provides the best shot at a good outcome.
and there’s not a patient — or hopefully, a doctor — who doesn’t want that.
lisa machado is the executive producer of advocacy & better health. send a note to lmachado@postmedia.com.
share story
