You’ve gotten a scary diagnosis and a referral to discuss treatment options. During the follow-up consultation, a surgeon says you need surgery.
You’re stunned at what you’re hearing. You want a second opinion.
Dr. David Hiller with Novant Health Pelvic Health Center - Winston-Salem not only supports that decision, he helps his patients find another doctor for an additional perspective. Board-certified in general surgery and in colon and rectal surgery, he wants patients to feel in control about what happens after diagnosis.
We talked with Hiller about how to broach the subject with your doctor and get a second opinion that enhances your ability to make the right decisions for you.
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How often do your patients want a second opinion?
A lot of what I deal with is colon and rectal cancer. This is a very hard diagnosis to receive as a patient, with a lot of new information quickly coming to them. When I tell patients about a big surgery, or we talk about chemotherapy or radiation, sometimes it can be more than what they were expecting. It's a shock to the system.
It's like, “I went to this other doctor for problem X and now you're telling me I need all these other things. How do I know that's right?” I think it's an appropriate response.
Do you find patients hesitate to tell their doctor they want a second opinion?
Yes. People feel like you’re locked into the person you have no matter what. It isn’t true. You shop for mortgages. You don't necessarily go with the first car you see on the lot.
Your body is the most important thing. It's strange that the only part of our lives where we feel hesitant is getting a second medical opinion.
Is there a process for finding an appropriate physician for a second opinion?
I, as the doctor, should offer it if I can tell that you're concerned about the choices. I'll tell patients, “Would it help you to talk to somebody else? I can call a colleague. It doesn't have to be a partner in my practice or a Novant Health source.” I'll make that connection with the other provider.
Otherwise, you can call up another doctor yourself and get an appointment. A lot of practices don’t require a referral. Or you can call your primary care physician and say, "I need to see someone else about this.”
The second doctor will need patient records. Is it ever a problem to get them from the original doctor?
It's easier now with electronic health records. For example, a majority of the medical record can be seen between ourselves and Atrium Health Wake Forest Baptist. If a patient wants to move to the other system, I know my colleagues there can see my documentation. It's important for us as physicians to be able to take care of that.
If patients are traveling out of state for a second opinion, I'll tell them, “I'm going to send the records,” but I'll also print out copies for them.
When I’m providing a second opinion, we request those records from (the physician) when the appointment is made.
If the original doctor bristles over a patient wanting a second opinion, is that a red flag?
That's definitely a red flag for me.
But is it even possible to get an unbiased opinion on your treatment? Don’t surgeons, for instance, tend to recommend surgery?
It definitely is possible. When you're seeking care, who’s giving it to you? Is it a board-certified person in that field? I think a physician’s credentials go a long way towards knowing what kind of advice they are giving. Is this their specialty?
For me, there's so much evidence-based research with rectal cancer, there are definitely times where I say surgery is not the answer here.
At Novant Health, every rectal cancer is getting the same evaluation and following best treatment practices. So, there is no, “This surgeon said surgery. This radiation person said radiation.” It's all in a group environment following established guidelines and best practices, and the outcomes are tremendously better for patients that way.
What about choosing a surgeon? What should patients look for?
First, see if they're board-certified in the field you need. There are studies showing a surgeon with board certification has better outcomes than one who doesn't. It's pretty stringent for most of us to get board certification.
Check websites for the societies which do certifications. If you need a urologist, you can go to the American Board of Urology and type in the name of the surgeon you're going to see. They'll tell you if the surgeon is board-certified or not.
It takes up to two years to get board-certified. One reason they may not have certification yet is that they have not completed the time requirements. If your surgeon doesn’t have the certification, did they do a fellowship or have specific training in what you need?
Ask them, "How many of these surgeries have you done?" We know the more of something you do, the better you are at it. After all that, look for a surgeon you feel comfortable with. If you don't feel confident or comfortable with them, it doesn't matter how many procedures they've done.
Anything else patients should know about asking for a second opinion?
Don’t be passive with your care; if you think you want a second opinion, go for it. Patients need to understand what is happening to their bodies and why we're proposing the things that we are. That’s how you're going to get the best outcomes and patients feel like their goals are being met.