I recently viewed a TV commercial for the Cleveland Clinic on MSNBC. One of the major themes of it was: Get a second opinion if you have a diagnosis of a cardiology condition. There is nothing surprising about a tertiary care center like Cleveland Clinic promoting second opinions. I have been a strong advocate for this in selected cases and have blogged about the idea many times (see: Seeking A Second Opinion as a Partial Solution to the DCIS Controversy; Fourteen Ways to Avoid Getting Screwed by the U.S. Healthcare System; Some Tips for Selecting a "Good" Doctor and a "Good" Hospital; Cleveland Clinic Use of Multidisciplinary Teams; Salaried Physicians Deemed Essential). What strikes me as different about this national advertising campaign is that the need for a second opinion is being planted in the minds of a large number of healthcare consumers. Here is a list of reasons why a patient should seek a second opinion from the Wikipedia article on this topic (see: Second opinion):
- Physician recommends surgery.
- Physician diagnoses patient with serious illness (such as cancer).
- Physician recommends a treatment for the patient other than what the patient believes is necessary.
- When physician recommends elective surgery, it may be required by the insurance plan. In other cases, insurance will not pay for a second opinion.
- Patient believes he/she has a condition that the physician diagnosed incorrectly or failed to diagnose.
- The physician himself/herself recommends a second opinion.
This is a good list to use as a starting point. I would add one more reason which is closely related to the list but not directly stated: to take advantage of special knowledge or diagnostic services that may not necessarily be available in the patient's home environment. I hasten to add that such services in cardiology would be available in numerous tertiary care systems other than the Cleveland Clinic.
For me, the most important reason for seeking a second opinion is the the patient has been diagnosed with a serious disease such as cancer, option #2 above. This closely follows from the idea stated in the previous paragraph because the treatments for various types of cancer are changing rapidly. Therefore, a patient with an aggressive cancer is best served by an oncologist who is familiar with all such options.
I want to list one more comment about the need for a second opinion as to the need for surgery (option #1 above). Indications for surgery can vary and some surgeons may be more inclined to operate than others. I also think that it's a good idea to consult with a second physician or surgeon who lacks a financial incentive to operate or perform a particular medical procedure.