Evidence-Based Medicine--The Patient's Perspective 5

“As you forecast, Curmudge, another week has passed and I am very much affected by my affliction. I don’t understand it. My physician diagnosed my illness and prescribed what she felt was the best evidence-based treatment. Quite honestly, she gave it her best shot.”

“Jaded Julie, it appears to be time for a second opinion. Consider your situation: (1) Your disease is serious and even life-threatening. (2) Your treatment doesn’t seem to be working or leaves you feeling worse than your disease. (3) Your diagnosis was difficult, performed by just one person, or was somewhat uncertain. Any one of these would lead us to consider a second opinion.”

“But won’t my physician be offended when I propose getting a second opinion?”

“If her primary goal is your good health and if she recognizes that no one can know everything, she will support your decision. That’s why there are specialists, subspecialists, and world-renown academic medical centers. If you look hard enough, you have a good chance of finding someone who can make a conclusive diagnosis and has successfully treated people with your disease. As we discussed back on June 18, 2009, errors in diagnosis do occur. When your disease is life-threatening, you want it to be diagnosed and treated by those who know it best. Remember, it’s your life.”

“Okay, Curmudge, I’m convinced. So please step down from your soapbox and tell me how to proceed.”

“Recall, Julie, that the objective of this series of postings was to teach you how to become a more informed and effective member of your health care team. So if you feel the need for a second opinion, begin by discussing it with your physician. Ask for her thoughts and guidance. Ask, ‘If you were in my situation, where would you go and whom would you see?’ Her answer might be someone across the street or across the country. She (or someone in the office) will tell you how to make the appointment and get your records sent to the appropriate destination.”

“A few weeks ago you quoted Meg Gaines as saying that one should ‘become an active patient ready to make your own way through your disease.’ What do I do if I feel that my physician’s suggestion for a second opinion is a bit conservative and I want to arrange the second opinion on my own?”

“Don’t go away, Julie, it’s possible. Let’s assume that you want your case reviewed by the specialists in an academic medical center and are uncertain where to go. Here’s one approach: Start with the U.S. News Best Hospitals rankings. Then select the specialty that fits your problem (you might not know the exact diagnosis, but you certainly know whether it’s Gynecology or Ophthalmology). A list of the best hospitals, in order, for that specialty will appear. Then follow your mouse for more detailed information.”

“I’ve found one whose reputation appears to be world class in my specialty. What do I do next?”

“The hospital’s Web site should tell you how to proceed. Oh, and by the way, you should probably check with your health insurance to learn if your second opinion will be covered. At some point you will need to authorize your physician’s sending your medical records—including labs, radiology, and pathology—to the second-opinion hospital.”

“This sounds like a big undertaking, Curmudge, especially if the medical center is a thousand miles away.”

“Some hospitals will evaluate your case on the basis of your records alone without your going there personally. The Cleveland Clinic (MyConsult) and Johns Hopkins (Remote Second Opinions) do this. Most commonly, their reports go to your personal physician. Partners Online Specialty Consultants is a physician-to-physician online second-opinion service provided by physicians affiliated with Harvard Medical School. The appropriateness of these programs may depend on the nature of your illness.”

“You wrote on May 13, Curmudge, about how we in the Fox Valley are blessed with quality medical care. In addition, there are two academic medical centers within the state and the Mayo Clinic only two hundred miles away. No wonder so many people around here simply die of old age.”

Affinity’s Kaizen Curmudgeon

Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.