machado: why are we so scared of asking for a second opinion?

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

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.

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.”

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.

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.

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.