By Dr. Ronald S. Dubin

Guest Columnist

 

As an orthopedic surgeon, I love talking about musculoskeletal injuries and back pain. So here I go again. Imagine for a moment your 75-year-old father who has been suffering from low back pain for years. Nothing has helped — PT, steroid injections, needling, etc.

So now he goes to the local neurosurgeon, gets an MRI and it shows spinal stenosis, herniated discs, and pinched nerves. He recommends having surgery for this. Wait you say, he’s 75 and has dealt with this for a long time. He still recommends surgery. You are anxious and not pleased with his decision. You are also smart enough in healthcare that, as a nurse, many of these MRI findings are very normal for a 75-year-old person. You realize that there is no such thing as a “normal MRI” in an older person.

You are really questioning if that is the cause and effect of these findings and by operating on these issues, will it solve the problem and be worth the risk of surgery? You want a second opinion. So he mentions a colleague for your father to go see in the same town. Two weeks later without a good exam on your father and barely reading the medical chart, he recommends the surgery.

Now you’re wondering if this was truly his independent recommendation. Or was he helping out his colleague? The truth of the matter is many second opinions are not truly independent opinions. Doctors are business people whether you want to believe it or not. They are influenced, as are judges and other professional people, by extraneous factors such as referral patterns, hospital affiliations, medical society influences or even members in a local golf club.

Let’s discuss here why you would want a second opinion: having major surgery, whether surgery is really necessary, difficulty diagnosing a condition, failure to improve, communication difficulties, failure of a first operation, bad reviews of the hospital or surgeon, questioning the motives behind the surgery, etc.

When you finally get your second opinion, you should be asking many questions and not just to confirm what your first doctor said. Such as maybe there are other reasons for his condition or maybe there are alternative forms of treatment. What if you decide not to treat him with surgery? Go over all the risks of both the surgical and non surgical treatment. Listen carefully as he will give you other things to consider. No two doctors are the same and each brings different ideas and thoughts to the table.

Talk about the recovery time. Or, if cancer, what is the life expectancy with or without treatment? Get several opinions, You will find that each will be different if they’re truly real second opinions unless the treatment is universally accepted like fixing a broken hip. So now you’re wondering why the two doctors are so different in opinions. The truth is that in many areas of medicine, there is no one correct answer. If you line up 10 neurosurgeons for your father’s condition, you will get 25 different answers to your questions.

There is no one correct answer. Sure, if you break your hip, you will need surgery plain and simple! But back surgery? Different story. So after reading this, how do you go about and really get an independent opinion?

This is what I recommend. If you want to tell your doctor you want another opinion, then do so. Don’t be timid or fear of hurting his pride. If they are confident of their recommendation, they will probably want you to get another opinion. If your second opinion is within the same medical practice, forget it. Don’t go there. Go outside that practice and maybe even go to another city not affiliated with your doctor. Or if you’re at a major university with a bucket full of neurosurgeons, go to a different university. When you do go, you will, of course, need to bring some of your medical records with you. What I recommend here is to black out the names of your doctor with a Sharpee, so he is not influenced by your doctor’s recommendation.

You will need to bring the MRI disc. If  it has your surgeon’s name on it  then that will require him to see it. Be honest with him and say you want his opinion. You don’t need to bring physical therapy records, but you do want all the important lab studies, EKGs etc. Again, black out his name and associated information.

Just remember, you’re not there to please your provider or your referral physician. You are there to take care of your father. PERIOD. It is your right to get a second opinion. Most doctors gets a second opinion for themselves anyways.

 

Ronald S. Dubin, M.D.

President, Kentucky Orthopedic Clinic

Middlesboro – Corbin, Kentucky

rdubin256@hotmail.com