- The Washington Times - Monday, June 27, 2005

For better or worse, Americans must really trust their doctors.

About half of those surveyed in a recent Gallup Poll said they “never” get a second opinion when their doctor “diagnoses a condition or prescribes a treatment, drug or operation.”

Of approximately 5,000 adults surveyed nationwide, 49 percent said they “never” seek a second opinion, 41 percent said they “sometimes” seek a second opinion and 3 percent said they “always” seek a second opinion. (The remaining 7 percent either did not have a doctor or responded “don’t know.”)

Doctors and researchers say the results of the poll were not surprising, but they split over whether 44 percent of patients getting second opinions is enough.

Richard Blizzard, principal consultant at the Gallup Organization and author of the article revealing the results on the Gallup Poll Tuesday Briefing Web site, was among those pleased with the number of people getting second opinions.

“You’re looking at 44 percent who are saying yes under the right circumstances they would get a second opinion,” Mr. Blizzard says. “That is pretty darn high.”

But Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality,a research organization within the Department of Health and Human Services, says the public can never be too informed about their medical options.

“The more informed people are about their health care, the better off they are,” she says. “A second opinion is one way of getting that information.”

The poll found that women are more likely to get second opinions than men. It also established education level as a factor in getting second opinions. Half the panelists with a college education said they always or sometimes seek a second opinion, compared to only 37 percent of those with a high school education or less.

Mr. Blizzard says patients with more education seek second opinions because “the more educated you are, the more trained you are to ask questions.”

However, the poll found little correlation between the state of a patient’s health and his or her likelihood of getting a second opinion.

Dr. Don Martin, an assistant professor of medicine at Johns Hopkins University in Baltimore, says although he wasn’t surprised by the breakdowns in the poll, he wishes more people would get second assessments.

“Being at least open to second opinions should be a much higher percentage than was reflected [in the poll],” he says.

Dr. Martin, who also has an internal medicine and rheumatology practice, says almost all of his new patients come to him for second opinions. He says many travel from abroad to get a diagnosis in the United States.

Doctors provided several reasons why some never seek second opinions.

“Forty-nine percent are obviously comfortable with their physician and their physician is comfortable with diagnoses and treatment recommendations,” says Dr. Donald Palmisano, who recently completed his term as president of the American Medical Association.

Mr. Blizzard points out that modern consumers are less likely to seek second opinions because many of them research their maladies before contacting a doctor. When they do come to an appointment, the patients know which questions to ask and can assuage their worries without having to consult another physician.

Dr. Clancy adds another reason: Seeking a second opinion can be intimidating.

“You’re not only saying, ‘Dr. G, I know you went to medical school and I didn’t, but I think you’re wrong,’ but you’re also saying to the other physician, ‘Is Dr. G a bozo?’” she says.

Dr. Victor Freeman, president of the Medical Society of the District of Columbia, a patient and physician advocacy group made up of Metro-area physicians and medical students, says the 3 percent who always seek second opinions represent specific types of patients.

“Some are people who don’t trust doctors at all, and they are always wanting to get a second opinion,” he says. “There are some people who just do it as a matter of being responsible to themselves.”

But according to Dr. Martin, those 3 percent are “probably overreacting.”

“For routine visits, most likely a second opinion isn’t needed,” he says.

Dr. Palmisano says in most cases a second opinion will confirm or differ just slightly from the original diagnosis. However, doctors identified several instances when asking a second professional might be a good idea.

Patients who aren’t responding to therapy; are facing high-risk, costly or experimental procedures; or are diagnosed with an unusual condition should ask for a second assessment.

Among maladies that are tricky to diagnose and may warrant a second opinion: spinal and lumbar problems, thyroid problems, syphilis, and rheumatological or neurological conditions.

Mark Brailsford, a 49-year-old information technology manager from Silver Spring, sought a second and third opinion after being dissatisfied with a proposed treatment for a pinched nerve in his neck.

The first specialist Mr. Brailsford visited suggested surgery to correct the problem, but Mr. Brailsford wasn’t keen on the idea.

“That surgery was going to be risky and involve a lot of time off work, and I decided I needed to try something else,” he says.

Mr. Brailsford contacted a second orthopedist who prescribed steroid therapy. After 10 days of therapy he realized the treatment would only be temporary and decided to try an alternative form of medicine.

“Somebody said, ‘Hey, you ought to try [acupuncture] and I went on the Web and found someone around the corner from my job,” he says.

Mr. Brailsford says that after three acupuncture sessions, his symptoms were greatly reduced.

Mark Goodman, a New Jersey-based neuropsychologist, has built a practice on providing second opinions to patients who are skeptical about their Alzheimer’s disease diagnoses.

Mr. Goodman says he would have predicted that 65 percent of all patients never seek second opinions, not 49 percent as the Gallup Poll indicated. He says the number of people who never get second opinions is unfortunate because many primary diagnoses, at least in his field, are incorrect. More than 80 percent of the patients Mr. Goodman sees have been misdiagnosed and in fact do not have Alzheimer’s disease.

Regardless of their condition, patients should never hesitate to seek out a second opinion, Dr. Martin says.

“Don’t worry about hurting the doctor’s feelings,” he says.

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