Second opinions can be invaluable. A study by the Mayo Clinic found that a diagnosis was changed or discovered in 21% of patients seeking a second opinion, and nearly 66% of all patients seeking a second opinion had their diagnosis refined. Receiving care for the wrong diagnosis or, more often, not receiving care for an undiagnosed issue can be life altering or sometimes even prove deadly.
Recently, a surprising number of patients have told me about experiences when their own initiative or a second opinion proved to be lifesaving. One patient was told that an incidental finding of low platelets (thrombocytopenia) was dismissed by his first physician as likely of little consequence. This patient sought a second opinion, and a bone marrow biopsy identified leukemia and led to treatment. Another patient’s doctor told her that a mass could be watched and that since imaging was not necessary, it would not be covered by insurance. She paid out of her own pocket for a CT scan that identified the cancer that she suspected she had. Multiple other patients shared similar stories. And whereas this may come as a shock to some, it is, sadly, not surprising to me. Physicians are not infallible. I genuinely believe that patients should be their own advocate. Good physicians support their patients seeking additional professional opinions. In fact, my patients and I share similar stories because a second (fifth actually) opinion saved the life – or more accurately the quality and course of life – of my son:
I count my blessings that my wife holds to her convictions and advocates for our family. Multiple “second” opinions at her insistence saved my oldest child from a lifetime of developmental struggles and unnecessary deafness. Our oldest effectively stopped talking at about 14 months old. He never had a diagnosed or suspected ear infection. And although he would eventually turn towards us when we called his name, my wife was convinced that he could not hear. She took him to multiple pediatricians and was repeatedly dismissed with the counsel that “boys will be boys” and “not everyone is a talker.” These were board-certified, well-trained physicians. Over the course of a year, his speech deteriorated from a dozen words at 14 months to only 2 words at 2 years old. A pediatric ENT, an audiologist and another pediatrician examined him and suggested autism, but when asked, they could not support their conclusions convincingly. The diagnosis just didn’t fit, as there were no other symptoms of autism.
Finally, at our second pediatric ENT and audiology appointment, the audiologist determined that the way sound waves bounced back from his ear drums was not consistent with open, air-filled middle ears. Dr. Matthew Whitley (Pediatric Ear Nose and Throat of Atlanta) scheduled an appointment to place tubes in his ear drums and explore further. Shortly into the surgery, Dr. Whitley discovered that my son had “glue ear,” which is when a glue-like semisolid forms behind the ear drum. Our son could hear sounds, which explains how he passed his first hearing test at one year old, but sounds were heard as if underwater, and he could not differentiate between many sounds which made speech unintelligible. Dr. Whitley inserted tubes, removed the glue-like material from our son’s middle ear and restored his hearing. Within one week our son went from speaking two words to twenty words. We were informed that in a case such as our son’s, it would likely have taken years for the glue ear to resolve on its own. Had we stuck with our first, second, third, or fourth opinion, our son would have been severely affected by deafness (and thus speech) during critical developmental years.
Mohs surgery is a method of curing skin cancer by removing small pieces of tissue and checking the edges under the microscope until clear, cancer-free margins are obtained. Mohs surgery has the highest cure rate (usually 99%) of any procedure for the most common skin cancers and is considered the gold standard treatment for skin cancer on the head and neck.
Physicians have an obligation to present patients with the most reasonable treatment options, even when that treatment option is not available in their own practice. I sleep well at night knowing that I genuinely give my patients treatment that I would not necessarily pick for myself. My job is to present facts and to be a guide but not to choose for my patients. Just today, I saw a patient who was referred to me for Mohs surgery of a basal cell carcinoma on the lower edge of the nose. We reviewed his treatment options together. He had never considered radiation therapy until I presented it as an alternative to Mohs surgery, and ultimately radiation therapy is what he selected. Likewise, I occasionally have patients referred to me for Mohs surgery who select imiquimod cream instead of surgery after I present it as a treatment option for certain types of basal cell carcinoma. When non-surgical options exist, it is a surgeon’s responsibility to help educate a patient about treatment options worth considering.
The providers at Premier Dermatology believe in second opinions and in patient advocacy. I, along with Kathryn Filipek, PA-C, strive to truly listen to our patients and empower them to seek second opinions and alternative courses of treatment. At Premier Dermatology and Mohs Surgery of Atlanta, whether we are your first or second (or fifth!) opinion, we make you and your family our priority.