Second Opinions

The concept of the second opinion has always carried with it some baggage, most likely related to the origins of medicine and its former paternalistic model of practice. In this model, you saw the doctor, the doctor told you their recommendation, you followed it. If you challenged it, you were usually met with a stern reproach or a flat dismissal.

A more patient-centered approach to healthcare, actually having a dialogue with patients and engaging them in the decision-making process, has been a welcome shift occurring in the practice of medicine as physicians become better at communicating and patients have become more empowered to be proactive in their care. However, even in this day and age, and even with me, a fairly warm and compassionate physician specimen, patients will sheepishly tell me that they are scheduled to see a second opinion before starting treatment. (I’m sure plenty of them don’t even bother telling me!) My reply, to their surprise, is always, “That’s great!” I explain that I am only happy if they are happy and the most important thing is that they feel comfortable with the care plan and with the provider who is putting it into action.

I look at it like this. Getting diagnosed with cancer is enough of a blow. Then you realize that you now face the following other challenges:

• Multiple doctor’s appointments in the midst of juggling work and family commitments
• Fear
• Having to learn a whole new language of medical terminology
• More fear
• Sifting through information on the Internet which is variable in its accuracy and applicability to your particular diagnosis
• Even more fear
• Navigating the waters of everyone and their mother giving you advice

The last thing you need is to not have full and utter trust in your healthcare provider and  your plan of action. To me, that trust is paramount to having a successful physician-patient relationship. You are entrusting your lives to us and no physician should take that trust lightly.

So, where do second opinions fit in? They can help give perspective and clarity to the information vortex in which you find yourself after a new breast cancer diagnosis. Some other benefits include:

• Piece of mind that you are doing the right thing, if the two opinions are in agreement (which most of the time, they are).
• Additional therapeutic options, when the doctors’ opinions disagree. While this can sometimes be disconcerting, it can also be important for you to realize that there could be other appropriate treatment options. This may necessitate a tie-breaker, see below.
• Repetition. While you might not want to be reminded of your diagnosis, repetition is actually good…meaning, getting an education about your disease and hearing it explained from a different perspective is important. After all, it is widely known that most patients only retain a small fraction of information from complex medical consultations.
• Doctors have different “styles” of practicing, even within evidence-based guidelines. So, while the specific recommendation might be similar, you might feel more comfortable under one person’s care than under another.
• Offices function very differently and have different complimentary services to offer. You might find that one office or hospital system fits your needs better than another.
• Second opinions are a widely accepted practice, and are encouraged by The American Society of Clinical Oncology, breastcancer.org, and The American Cancer Society, just to name a few. 

REASONS NOT TO GET A SECOND OPINION (MYTHS DEBUNKED):

• My doctor will get upset.
  • A doctor who gets upset about you requesting a second opinion should raise some skepticism. Yes, doctors have egos like any other professional. However, for those who are practicing evidenced-based, compassionately-delivered medicine, they should not be concerned by someone going to another place to get another point of view.
• It will not be covered by my health insurance.
  • Most insurers cover second opinions. Medicare pays 80% of the cost.  
  • Some insurance carriers actually require a second opinion before initiating therapy.
  • Either way, it is good practice to check with your insurer to better understand the covered expenses for your specific plan.
• It’s time consuming.
  • Unfortunately, this is actually true for a majority of traditional medical practices. But I think this will be changing very quickly as patients start demanding better customer service…after all, the medical field has long been antiquated in this regard. Finding a more efficient and patient-centered approach to healthcare is going to be essential as our population continues to increase and become more and more technologically savvy while the supply of physicians is diminishing. The advent of telemedicine, currently used mainly in the primary care setting and psychiatry, is now expanding into other specialties and practices, as demonstrated by my practice, Breast Cancer Consultants. Patients are no longer chained to the waiting room chair for indefinite periods of time and finally are getting some much-needed control in the physician-patient interaction. 

GENERAL ADVICE FOR SECOND OPINIONS:

• See a breast cancer specialist.
  • There are lots of people who treat breast cancer across the country but there is a smaller collection of specialists who focus SOLELY on patients with breast cancer. You want to be sure that if you are taking the time and effort to see someone, you are seeing someone who is attending the important breast cancer meetings and staying current on all the latest breast cancer research.
• Don’t shop around for the answer that you WANT to hear.
  • While physicians should take into consideration an individual’s wishes regarding their care, the recommendations should always be guideline-driven. After all, this research is done in order to save lives and guidelines are established for that very reason. That being said, there are clearly cases where those “guidelines” don’t fit the case. In those situations, doctors should explain to you that you are in a “gray zone” and provide you with the information you need to make an informed decision for yourself.
• Go with your gut.
  • You need to feel comfortable with your care. This is big stuff you are about to embark on and a very important relationship in your life. You should feel supported and safe.
• Consider a tie breaker.
  • If your first two opinions differ significantly, it is reasonable to consider a third opinion as a tie-breaker. A third opinion is even covered by Medicare in cases where the first two opinions disagree.

So, the bottom line is, don’t feel ashamed to advocate for yourself. Get the answers that you want/need to make you feel strong and ready for the fight ahead. You are worth it!

Musings on a new venture…

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Let me start out by saying that this blog is intended to be a place for me to update you on the latest information out there about living well after a diagnosis of breast cancer, including interpretations of information in the lay press and other interesting information I come across that I feel it would be important to post. However, for this one entry, my first, I would like to give you some insight into my journey and why I am so passionate about this new role.

In retrospect, all of this does seem a little cliché. After all, I hit my 40's and all of a sudden here I am in a major career change. But to me, as I reflect on this change now, I see some parallels between the journey of a woman who is newly diagnosed with breast cancer and my own choice to chart a new course for my career. 

Through 9 years of post-graduate training, I had a clear path. I knew where I was supposed to be and what I was supposed to do and what was expected of me. Though very physically and mentally challenging, I felt fortunate that I had a path. When I finally got my first real job at age 31, I was so excited to be doing exactly what I set out to do; treat breast cancer patients. It was very exciting and scary at the same time.

It remained that way for quite some time. However, over time, I began to understand the realities of practicing medicine in the US. The demands of seeing a large volume of patients and trying to deliver the standard of care to which I was accustomed began to be at odds with each other. I became increasingly frustrated. I began contemplating all sorts of crazy career ideas. My mother instilled in me the love of baking pies and at one point I was very close to closing up shop and opening a pie business. Then I realized, those 4 AM mornings were probably not for me.

About a year or so went by with me wondering how best to utilize my skills in a way that will challenge me but will also feel gratifying. I started noticing my patients’ frequent concerns regarding the scheduling, waiting and general inconvenience of traditional medical practices. They would often say, "I love seeing you but I hate waiting in the oncology office". Or, "I love seeing you but the parking here is so expensive, is there anything else we can do?”. I also would frequently get emails and calls from friends or family members about someone they knew who was newly diagnosed with breast cancer, asking if I would be willing to speak with them and give them some guidance.

Then, the light bulb went off. People want timely, accurate and personalized information when going through a medical crisis, like a diagnosis of breast cancer. Why can’t we take away all the barriers to providing this service in a traditional practice and get right to the heart of what’s needed, which happens to be what I love doing…educating and empowering patients and their loved ones to make their own best health decisions?

So here I am, taking a major leap of faith, about to embark on a very new venture and might I add, unchartered territory. I am learning new things on a daily basis and growing in a way that I couldn't have imagined in my previous career. While scary, at the same time I have this incredible sense of calm because I finally have control of my path.

And here's where we come back to the parallel. Though the change is admittedly quite different, we are both looking for the same thing; a sense of control and peace of mind that we are doing the right thing. My work as a breast cancer consultant aims to provide control and empowerment through education and compassion to women who are thrust into a diagnosis of breast cancer. 

Here’s to both of us for finding our way!