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opinion | Jerry Cianciolo

Too many patients forgo getting a second opinion

Hannah barczyk for the boston globe

Recently, I accompanied a friend to the doctor. He was having occasional tightness in his chest. That morning, once Steve’s vitals were taken, a young cardiologist greeted us. We all shook hands and she asked Steve to describe his symptoms. The conversation lasted maybe three minutes, at the end of which she said: “I recommend angioplasty.”

What was startling wasn’t the diagnosis — it was the speed with which the doctor delivered it.

This was the cardiologist’s first meeting with Steve. She hadn’t yet seen the results of his angiogram, nor did her new patient have a history of symptoms. Nevertheless, she was confident that stents and balloons were the way to go.

In her defense, angioplasty is routine today — the mortality rate is under one percent. Still, threading a metal tube through the femoral artery isn’t lasering a wart.

When I gingerly raised the possibility of a second opinion to my bare-chested friend, he demurred.

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Which, according to a 2010 Gallup poll, is just what 70 percent of us do. Regardless of education level, Americans instinctively trust the accuracy of their doctor’s advice even when, as in this case, the internist is a stranger.

That’s surprising for a number of reasons.

One, according to the Patient Advocate Foundation, 30 percent of patients who sought second opinions for elective surgery found the two opinions differed.

Two, physicians themselves debate the value of procedures such as prostate screening, hormone replacement therapy, back surgery, and, yes, even angioplasty.

Three, some physicians prefer monitoring while others opt for aggressive treatment.

Four, insurance companies will often pay the full or partial cost for a second opinion.

You would think with a serious illness that may require extended treatment, the majority of us would seek the comfort of a second opinion. But that isn’t the case.

When my daughter was young, she had hearing problems. The specialist we visited looked into Laura’s ears and almost immediately began pecking at his laptop. “What do you recommend?” I asked.

Without glancing up, he replied as if it I’d asked perhaps the world’s dumbest question: “Tubes of course.”

Knowing that inserting tubes meant general anesthesia, I thanked the doctor for his time and said we’d seek another opinion.

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A day or so later a second specialist said my daughter’s eustachian tubes were likely filled due to pollen. He was right. By June she could hear the proverbial pin drop.

Tubes may have worked fine, but why the haste on the part of this ear specialist, and why the swift diagnosis by Steve’s cardiologist?

Various factors may be in play. Of course, there’s the scheduling crunch. At some hospitals, doctors are expected to see a patient every 11 minutes, according to a 2014 Washington Post article. There’s physician confidence that comes from years of training. There’s the desire for doctors to have a ready answer for apprehensive patients. There’s the specter of malpractice should something happen quickly. And, for a few unsavory practitioners, there’s the profit motive.

Whatever the reason, deliberation is shunted aside often at the patient’s expense.

Two years ago, as I lay in bed, I was alarmed to hear my own heart beating with wildly irregular thumps.

Within a week I had undergone an EKG, a stress test, an ultrasound, and under my shirt had worn a holter monitor for 24 hours. Eventually I was diagnosed with premature ventricular contractions, known as PVCs, and sent to a cardiologist.

“Let’s put you on beta blockers,” he said, after a cursory look through my file.

“Maybe it’s just stress,” I suggested, as I’d been caring for my terminally ill mother, around-the-clock, for the past few months. “Beta blockers work well for PVCs,” he assured me.

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True enough, but in some patients they also cause fatigue, constipation, dizziness, trouble sleeping, depression, and loss of sex drive. I thanked the cardiologist and sought another opinion.

Soon after, I learned I didn’t need beta blockers, or any medication, as PVCs are rarely life-threatening and sometimes disappear. Sure enough, for the past 18 months my heart has ticked with the regularity of a quartz movement (as have advances to my lovely wife).

Like all highly trained specialists, physicians practice to the best of their abilities, relying on the very latest research. And given the complexity of the human body, and the many unknowns, the majority do a superlative job.

Still, much of our anatomy is a mystery (why, for instance, can our appendix be removed without obvious harm, and blushing and yawning — what are they all about?)

One day, genome sequencing may penetrate our inscrutability. But until then, two heads — and two opinions — are surely better than one.

Related:

Dr. Angelo Volandes: Prescribing the end-of-life conversation

Alex Beam: Skip the annual physical? No way, it’s my yearly lease on life

Evan Hempel: ‘Fail first’ fails patients


Jerry Cianciolo is a writer and also chief editor at Emerson & Church, Publishers. He can be reached at jerryjcianciolo@gmail.com.