Getting a second opinion

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Conscientious doctors welcome consultations and encourage second opinions. Because there are many gray areas in medicine where judgment and experience are as important as knowledge, consultations are frequent. Many insurance companies require second opinions. If, after discussions with the doctor, you are still uneasy about any aspect of your childs medical care, you should not hesitate to seek another opinion.

There are two ways to get a second opinion: see another specialist or ask the childs physician to arrange a multidisciplinary second opinion. Many parents seek a second opinion at the time of diagnosis. Do not do this in secret. Explain to your childs oncologist that before proceeding you would like a second opinion, and ask for his recommendation. The Childhood Cancer Ombudsman Program (see Appendix C, Resource Organizations), with dozens of participating board-certified pediatric oncologists, will review your childs treatment plan and offer second opinions without charge. To allow for a thorough analysis, arrange to have copies of all records sent ahead to the physician(s) who will give the second opinion.

Multidisciplinary second opinions incorporate the views of several different specialists. Parents who would like to get various viewpoints can ask to have their childs case discussed at a tumor board, which usually meets weekly at major medical centers. These boards include medical, surgical, and radiation oncologists, as well as fellows and residents. Your childs oncologist will present the facts of your childs case for discussion. Ask him to tell you what was said at the meeting.

Doctors informally seek second opinions all the time. Residents confer with their fellow for complicated situations; fellows might confer with the attending when unusual drug reactions or responses to treatment occur. Attendings call colleagues at other institutions. Parents should feel free to ask their physician if he has conferred with other staff members to gain additional viewpoints.

Brent developed a seizure disorder after a rare drug reaction, so he was on anticonvulsants as well as chemotherapy for two years. We worried about the interaction of all the drugs, as well as the advisability of his continuing on the more aggressive arm of the protocol. We asked the fellow to arrange a care conference, and she met with the clinic director as well as Brent's neurologist to discuss how best to manage his case.

Parents often fear seeking a second opinion because they are afraid of offending the doctor or creating antagonism. Conscientious doctors will not resent a parent seeking a second opinion. If she does resist, ask why. Second opinions are common and accepted practice. Indeed, many insurance companies require them.

Two opinions that agree are all that parents need before proceeding. Treatment usually begins within days of diagnosis, after all questions have been answered and other opinions have been obtained. Needless delay in treatment should be avoided.

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