Second Opinions

Patients are frequently advised, or decide on their own, to seek a second opinion after a recommendation to undergo an operation. That seems reasonable but it can actually result in more uncertainty than existed prior to the second opinion.

When the surgeon agrees with the first recommendation the patient should be reassured of its appropriateness. This is the usual scenario. But now the patient must decide with which surgeon they feel most comfortable. I have provided second opinions and my experience is that, unless there are insurance provider issues, the patient is more likely to choose the surgeon giving the second opinion. Perhaps, even if unrecognized, that’s because for some reason they weren’t entirely comfortable with the initial surgeon. The patient is stressed, however, when the second surgeon disagrees with the first. The new opinions vary from recommending against surgery, to a different operation, to either use or non-use of other therapies such as radiation or chemotherapy before the operation. There is no easy way out of this dilemma; getting a third opinion will break the tie but probably leave the patient a little wary as the “minority surgeon” must have believed in their approach. Having expressed a caveat, it’s my experience, having been both the first and the second surgeon, that most times there is agreement and the patient is reassured—and more informed as they are the recipient of two explanations and discussions of risks and benefits of an operation.

How do surgeons feel about the second opinion scenario? In some sense it doesn’t matter as it’s the patient’s right. Thoracic surgical patients seeking second opinions are not all that common but it is, or at least should be, not a problem. I felt it wisest to encourage the patient to find the second surgeon on their own to avoid the appearance of choosing a friend who would agree and return the patient. When providing the second opinion I ended the session by saying I would convey my assessment to the initial surgeon and the original referring physician. I did not solicit but if asked to assume care I assented, again communicating with the other physicians.