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How to Ask for a Second Opinion
WebMD Medical News How to Ask for a Second Opinion ..
WebMD Feature Archive Archive
.. May 15, 2000 -- In an interview with WebMD, Jerome Groopman, MD,
author of Second Opinions: Stories of Intuition and Choice in the Changing
World of Medicine, summarizes valuable lessons from seven life-and-death
WebMD: What situations demand a second opinion?
Groopman: Any time you have a very serious or life-threatening disease:
Where the diagnosis is not clear, the treatment is experimental,
or there is no established consensus or Food and Drug
If you're considering participating in a trial for a new drug
If you're considering some new experimental approach or a
procedure that involves using experimental instruments or devices.
WebMD: We all fear being the "demanding" patient. How should you ask for a
Groopman: I think we all want to be polite and civil and don't want to spark
an adversarial relationship. Yet, I feel very strongly that any time a patient
raises the issue of a second opinion, a physician should welcome and endorse
WebMD: Should you always tell your doctor if you're seeking a second
Groopman: Absolutely. One, you need all the medical records and any
pathology slides or other test results to give to whoever is giving the second
opinion. Two, you want the experts to discuss in an open way what the areas of
agreement and disagreement are. If you don't tell your doctor because you're
afraid you're going to insult him, it's hard to get the records together and
WebMD: Should you ask your doctor to recommend someone for a second opinion?
Groopman: You can, but it's important to see someone at a different
institution. Institutional cultures are real, and often an opinion leader at
one hospital will do things a certain way and others at that institution will
conform to that viewpoint. But at another hospital, even across town, there may
be a very different philosophy.
WebMD: What if your health plan doesn't say anything about how it covers
Groopman: This is one of the major flash points for a patients' bill of rights
and the whole issue of managed care. Each plan differs as to the level of
choice and freedom you might have to see someone inside and outside the
network. If you're restricted, or in a situation where the diagnosis is not
clear, or you feel the best treatment exists at another institution, then you
need to advocate for yourself quite loudly.
WebMD: A recent study of biopsy slides at Johns Hopkins published in the
December 1999 issue of the journal Cancer showed a surprising rate of
misdiagnoses. Is it realistic to ask for a second medical and lab or
Groopman: Always. Absolutely. I saw a woman recently who had sought three
"second" opinions in Boston. She had been diagnosed with a breast cancer that
was characterized by the genetic marker HER2, a marker for a very aggressive
breast cancer. If staining of the tissue by a pathologist shows this, it means
that you're eligible to be treated with a new medication called Herceptin. It
also means you have a much more aggressive form of cancer and need chemotherapy
As part of my assessment, I sent the slides to our pathologist and he said, "I
just don't think this is HER2. I think there may have been a technical error in
the staining." We repeated the lab test and it was negative. She's done
extremely well on hormones, which are not toxic, in contrast to a course of
intensive chemotherapy -- without probable benefit -- and Herceptin, which
wouldn't have worked for her.
WebMD: What if you are convinced that your opinion is correct and the
patient wants to do something you feel won't work?
Groopman: I try to present my advice in as compelling a way as possible. I
suggest that they see other specialists because sometimes the weight of more
than one opinion helps. But the ultimate choice is the patient's. No one's
going to shackle him and take him to the operating room in the middle of the
Alice Kahn, RN, NP, spent eight years as a reporter and columnist
for The San Francisco Chronicle. She currently works as a clinician in
the Chemical Dependency Recovery Program and as a research nurse-practitioner
in the Women's Health Initiative Hormone Study at Kaiser Permanente in Oakland.
She is the author of five books, including Your Joke Is in the E-mail. ..