Second Opinions

By Christine Gorman

Have you ever considered asking your doctor about getting a second opinion, then decided not to risk it? Maybe you were worried that she would feel insulted. Or that he would abandon you in a fit of pique. You're not alone. No matter how many times we're told that doctors are professionals and won't take it personally, lots of us still have trouble challenging their recommendations. That's too bad, because getting a second opinion often makes a confusing or complex decision about treatment easier to deal with. Sometimes it can mean the difference between life and death.

The right to a second opinion has become a rallying cry in the ongoing debate over how far managed-care companies should be allowed to go to keep costs down. Seven states, including New York and California, have passed laws to guarantee patients the option of getting another point of view. Other legislatures will probably follow suit, which is somewhat ironic. "Second opinions used to be seen as a way to keep [doctors] from overtreating patients," says Todd Wagner, a health economist at the Veterans Affairs Health Care System in Palo Alto, Calif. "Now they're being looked at as a way to keep [patients] from being undertreated."

There is no one-size-fits-all set of guidelines for knowing when you need a second opinion or how you should go about getting one. But the best primer I've seen on the subject is a new book called Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine by Dr. Jerome Groopman of Harvard Medical School (Viking, $24.95), due in bookstores this month. Second Opinions is not so much a how-to guide as an insider's view of how doctors and patients determine--often with limited facts--the best course of treatment. "Dealing with uncertainty is difficult for everyone, including doctors," Groopman says. "We all want to believe in the perfect solution."

A few basic lessons, however, do emerge. At the top of the list: a second opinion should include a second physical examination and a review of the original pathology slides and other tests, if any. Otherwise, the second doctor is assuming that the first doctor's diagnosis is correct.

If you feel you have no other options, that's precisely when you need a sober assessment of all the risks and benefits. Be especially sure to get a second opinion if you're told you need an experimental treatment. "Researchers tend to fall in love with what they're doing," Groopman notes.

Make sure the physician you consult is truly an independent judge. It's only natural for doctors who work in the same hospital to share views or want to avoid second-guessing their colleagues.

Don't overdo your search. Sometimes if you find yourself looking for a third, fourth, fifth or sixth opinion, what you're really doing is running away from the truth. No one knows that better than Groopman, who hurt his back 20 years ago and was told to rest until it healed. Not satisfied, he went doctor shopping until he found a surgeon who promised to fix it. Unfortunately, Groopman wound up in worse shape after the operation. Now, after two decades of suffering and intense physical therapy, the physician still hasn't completely healed himself. Sometimes, as Groopman learned the hard way, the best course is to do what your original doctor ordered.

For more information about second opinions, visit time.com/personal You can send Christine e-mail at [email protected]