What if the Second Opinion Is Different? Help for Mysterious Symptoms. Plus: What to Do When Your Doctor Is a Student.
Question: Leslie, I'm really enjoying your book, but there's something I'm unsure about. You talk about always getting a second opinion, but what if I get a second opinion that contradicts the first doctor's opinion?
Leslie Michelson: It’s a good question. Because if there was no chance that it might happen, then there would be no point in getting a second opinion, right?
The key is to get the second opinion from an expert who's got greater expertise and spends more of his or her time on your specific condition than your first doctor. So, it's not merely a "second opinion" but an expert opinion. And if the expert opinion differs from your first doctor’s opinion, there are two ways to resolve it:
• First, you want to go to another specialist who has even deeper expertise in exactly your condition.
• Second, immerse yourself in the medical literature on your condition. Read as much as you can about your issue and get the benefit of evidence-based research.
When you do both of these things, you're more empowered, better informed, and you're going to avoid getting into a 51-49 coin toss kind of situation.
Question: I'm about to have an operation in a teaching hospital. It has a great reputation, but I'm concerned that a student will end up doing my surgery instead of my doctor. What can I do?
Leslie Michelson: Academic medical centers are wonderful institutions. But as a patient, they can be very confusing. There are interns, residents, fellows, house staff, attendees... It can be hard to figure out who's in charge.
The first thing you need to do is understand the hospital's organizational structure. Each and every time someone comes to treat you, ask what is their role: Are you a resident? Are you an attending staff? The reason is that different tasks require different levels of expertise. If the job is simply inserting an IV in your arm or getting you set up for diagnostic tests, more junior people certainly have the capability to do it under the guidance and supervision of a more senior person.
But if you're about to undergo an extraordinarily complex esophageal cancer surgery, or an aortic valve replacement, you want the most senior person to be responsible. Which doesn't necessarily mean that they need to do all of the procedure, but they need to do the key parts and be present to make sure it all goes right.
So, here's a tip, when it comes to your surgery—and I've done this many times. Just say to your surgeon, "Dr. Smith, I am really nervous about this surgery. I know you have fellows that you need to train, so that they can become as good as you are. But can you promise me that you're going to be there in the operating room? And that you're going to be the person who does the procedure?"
Every time I've asked this of a physician, it's appreciated. The response is always, "Absolutely. I'll probably have some help from the students, but I will be there. I will be doing it."
Question: I’m a 44-year-old woman. I consider myself very healthy, aside from some musculoskeletal issues in the past, including scoliosis, ankle surgery, and a car accident. But for about nine months now, I've been dealing with ongoing acute and debilitating migraines; nerve pain in my neck due to disk issues; numbness in my hands and toes; twitching; and hair loss. I've seen a neurologist, a spinal specialist, an osteopath, a physical therapist. All are trying to help. My father died of ALS close to the age that I am now. I'm not sure what to do.
Leslie Michelson: The first thing I have to say is my heart is with you, and I’m so sorry about your father. Those are a lot of symptoms you are dealing with. They're presenting in an unusual way. And I'm sure that you’ve been going to good physicians, but no matter how good they are, this is the time to get fresh eyes on it.
This is the time to collect all of your medical records. This is the time to organize them in a binder, so that other physicians can look through them. And this is the time for you to identify an expert in neurology. That's not to disrespect any of the physicians who have been working diligently to diagnose and treat you, but just to recognize the objective truth that every so often, fresh eyes can make a really big difference. This sounds like one of those times to me.
To find an expert, I would speak with a physician who's treating you, someone with whom you feel the most trust and rapport—maybe that’s your internist, or your OB/GYN, or your orthopedist—and say, "Look, I've got this situation. I really want to find one or more doctors who are really good diagnosticians, who can look at this fresh, because they might see something that others haven't."
You may also want to look at the websites of the best academic hospitals near you. For your collection of symptoms, you may want to reach out to specialists in the neurology and endocrinology departments.
Here's another tip, something I do all the time. You can call the office of the chairman of medicine at the hospital, tell them, "I'm 44-years old... Here's what's been going on with me... Is there somebody the chairman of medicine can recommend, who can sit down, take a fresh look at everything that I've been through, and get me on a healing path?"
When I've done that, they almost always come back and give you an excellent recommendation. And I'll tell you a little trick of the trade. Sometimes the best physician's calendar might be booked for a couple weeks or even months. So when you make that call, just start by saying, "I've just been referred by the chairman of medicine. Can I get in next week?" I'm not suggesting any deception whatsoever! But I got to tell you, it works.
*Editor's note: For anyone who's facing a potentially serious diagnosis, be sure to read Leslie's tips in, "8 Questions to Help You Avoid Diagnostic Error."