SECOND OPINION: 101

http://www.childrenshospital.org/arthur/pop_surgeon_en.html

CNN Health reports that there are five situations where you should take a second medical opinion. These include brain tumors, hysterectomy, medical termination of pregnancy in fetal abnormalities, varicose vein surgery and heart bypass surgery.
I think this is silly pop stuff. What about a diagnosis of tuberculosis versus lymphoma, or cancer, or Crohns’ disease? What about whether a hernia or a gallbladder needs a surgery or not?
There are three main reasons I think a second opinion is important:
1. What is it?
Recently I saw a young girl who was being treated for several months for proven tuberculosis of her lymph glands in her neck. In spite of the treatment, her glands were increasing in size, and I removed a piece, thinking it to be a case of drug-resistant tuberculosis, which is an important health issue all over the world. When the biopsy report came, I was surprised to read the report stating that there was no tuberculosis at all. What would one do now? One report was clearly declaring the presence of TB, and the other (from an equally reliable lab) was refuting it. In the past, I have found a diagnosis changing from TB to cancer! Similarly, TB of the intestines (a very common Asian disease) may be confused with cancer or Crohns’ disease, which, though uncommon, are important diagnoses.
In these cases, it is important to get an experienced specialist to decide further course of action.
2. To treat or not to treat?
Investigations have become commonplace these days, with people going for comprehensive check-ups just to find out if they are okay or not. In addition, people go for thorough health check-ups before they are hired for new jobs, or prior to getting life insurance. These tests are throwing up diagnoses of diseases. People get worried about these findings and queue up for treatment, including surgery. A common example is a young man who is found to have gallstones, or a sailor with a small hydrocele.
It is very important not to treat these people unnecessarily. “You can’t get better than asymptomatic” is a truism for the over-enthusiastic doctor. The patient should earn the surgery, and the surgeon should not sell it. So, in case a doctor recommends surgery or another invasive procedure (like an angiogram) for something that is not troubling you too much, it is good to get a second opinion.
Another example is appendectomy for chronic pain in the right side of the tummy. This is a total no-no, in most cases. Surgery is not needed in more than 90% of cases, as the diagnosis itself is not appendicitis! This is so common that I find it ridiculous that CNN does not talk about it, dealing instead with rare stuff like birth defects detected in pregnancy.
3. What treatment to follow?
Let us take the operation of hysterectomy (removal of uterus). Recently a young woman of 39 years came to me with a tumor (myoma) in her uterus. She had heard that I do laparoscopic surgery, and wanted to hear from me that I would be able to remove this by the keyhole method.
She showed me a previous consultation with a gynecologist (note that I am not one), and this guy (with international degrees, working in one of India’s best hospitals) had told her, “You need an open operation to remove your tumor, because it has become very big.”
In this day and age, I thought, my Gawd!
Here is why I was shocked: it is now established by science that most uterine tumors (and we are not talking of cancer) do NOT need surgery. If treatment is needed at all, it can be something even less invasive than keyhole surgery. In other words, uterine artery embolisation, a procedure whereby a tiny tube is placed from the groin into the artery of the uterus and the blood supply to the tumor cut off by injecting some magic materials. The tumor shrinks because its blood vessels get clogged. End of story. But, no, this is not good enough for many of the gynecs, who want to get their hands into blood, and feel they are actually doing something.
This is another example of when a second opinion should be solicited, and CNN does mention it, to its credit.
So what should you do when faced with a new disease, or with a surgery for something you are scared of? Chances are that the second opinion you take will be equally wrong, or end up confusing you thoroughly. This may be less so in the US or in Europe, for example. In India, it would be most likely! For example, those people who come to me for getting their appendixes removed have already got the same opinion from three other doctors, including medicine specialists and gynecologists. They get shocked when told that no surgery would be needed. It is only because they trust my opinion that their confusion is resolved. If not, they probably get the surgery done by someone else, and, much later, when the pain recurs, remember my opinion.
So, the thing to do in the situation I described is to read. Doctor Google. Web MD.
And some doctors’ blogs!

6 responses to “SECOND OPINION: 101

  1. //And some doctors’ blogs!
    Glad I’m doing that 😉

  2. Pingback:   SECOND OPINION: 101 by cancer.MEDtrials.info

  3. This has happened to me in the past once… I had an issue in my stomach area and 3 doctors said “No Laparoscopy, has to be Open Surgery”… but finally I took a Fourth opinion and went for Laparoscopy. Three years later, I am alive and healthy. Now I give this advice to everyone to at least consult more than one doc about this method, when in need of surgery. But of course, not in all the cases. Caesarean can still not be performed with Laparoscopy, can it Doc? 😉

  4. “You can’t get better than asymptomatic” is a truism for the over-enthusiastic doctor.//
    This sums up the post. Very informative post.
    “it is now established by science that most uterine tumors (and we are not talking of cancer) do NOT need surgery. If treatment is needed at all, it can be something even less invasive than keyhole surgery.”
    I was suggested surgery for uterine tumour 10 years back and I am managing very well without the surgery even after a decade thanks to the doctor who advised me against it.

  5. I believe in second opinions, yes even for minor ailments if strong medication is prescribed. I read web md quite often. Basically I am the kind of person who hates medication! But ofcourse will take it if absolutely necessary. i have had several experiences where I have been wrongly diagonosed. as we often move around, one has to go to unknown docs. but down here in pune, mumbai thankfully we have close relatives who are docs and they always recomend the best docs if needed.

  6. This is a very informative entry. Thank you.

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