-->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 stories.
WebMD: What situations demand a second opinion?
Groopman: Any time you have a very serious or life-threatening disease:
- Where the treatment is very risky or toxic
- Where the diagnosis is not clear, the treatment is experimental, or there is no established consensus or Food and Drug Administration-approved treatment
- 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 second opinion?
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 it.
WebMD: Should you always tell your doctor if you're seeking a second opinion?
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 communicate.
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 second opinions?
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 pathologist opinion?
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 immediately.