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Common sense, second opinion

Is It Prudent To Seek a Second Surgical Opinion?

 By Dr. Gifford Jones  Tuesday, October 12, 2010

When is a second surgical opinion an absolute necessity? And when should you accept your own doctor’s advice? These have always been thorny questions when people are stricken with disease. Today they are even more important when technology often takes precedence over good sense. And when health care funds are scarce.

Don’t get a second opinion when the problem is self-evident. Gallstones causing repeated attacks of pain require surgery. So do large fibroids associated with abnormal bleeding and pain. And if you have troublesome and visible varicose veins or hemorrhoids, you don’t need a second physician to confirm it.

So when should a red light begin to flash? In 1922, a future president of the American College of Surgeons wrote that regrettably “there are some surgeons who will operate on anybody who will stand still”. A rather damning accusation, but there’s an ounce of truth in this statement.

In business it’s often said, “Let the buyer beware”. Luckily, to a much lesser extent, the same advice holds true for surgery. But certain facts prove that patients must remain alert and questioning.

For instance, how to explain this data? If you live on the west coast of the U.S you are three and a half times more likely to have prostatic surgery than if you live on the east coast. Is it reasonable to blame this on climatic conditions?

A former professor at The Harvard Medical School once said, “You can never make a patient feel better who does not have any symptoms!”

It’s therefore prudent to raise a red flag if surgery is advised and you’re free of pain, abnormal bleeding, lumps or other problems.

Freedom from symptoms however, does not always translate into freedom from disease. I vividly recall removing a 33 pound ovarian cyst from a woman who had no medical symptoms. Her only complaint was church related. She could no longer squeeze between the pews!

Often women who show an abnormal Pap smear have no symptoms. Similarly a routine colonoscopy may reveal an unexpected malignant tumour in the large bowel. Delaying treatment to seek a second opinion makes little sense.

One of the dilemmas today for patients is 20th Century technology. It’s a great blessing for some patients where early diagnosis means the difference between life and death. But for others it can pose further and often needless distress.

It’s been said facetiously that, “A well patient is someone who hasn’t been examined by enough doctors.” I would add “It’s also someone who hasn’t been examined by enough machines.”

CAT scans, MRI’s and ultrasounds often detect problems or abnormalities during the course of a diagnostic workup. But the presence of some disease does not necessarily mean the disease must be surgically treated.

For instance, if gallstones are diagnosed and there have been no symptoms related to the gallbladder, but the surgeon wants to operate, get a second opinion. If you leave them alone the crematorium may take care of them at 90 years of age.

Get a second opinion if you face debilitating surgery. Remember the surgeon does not have to live with the consequences of the operation. You do, and the quality of your life henceforth may not be acceptable.

All too often I receive letters from readers stating that if they had only known the complications of an operation, they would have said “no” to it. As they say in the Holiday Inn ad there should be no surprises after surgery.

A second opinion may also be helpful when there’s a difference of opinion among surgeons about the type of operation to be done. One surgeon may stress that a malignancy of the large bowel can only be cured by colostomy. Another surgeon may be willing to attempt a procedure to save bowel function.

I see patients everyday whose diagnosis is obvious, as is the treatment. There’s no need for multiple consultation. But it is nevertheless the wise thing to suggest in order to convince the patient.

Some people sustain a higher level of anxiety when facing even a non©life threatening operation. They have a look in their eyes which doctors instinctively recognize. Unless a second opinion is obtained the patient will have no peace of mind, and their recovery more difficult.

A Spanish proverb states that, “Among the safe courses, the safest of all is to doubt”. Or as Stanilaus Leszcynski, the King of Poland remarked in 1763, “To believe with certainty, we must begin with doubting.”

A little doubting never does any harm when major surgery is advised. And if there’s too much doubt in your mind the best approach is to obtain a second opinion.

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones

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