Comment by Trusteando
4 days ago
When opinions conflict, if the first opinion is right and the second opinion is wrong you could end up receiving an unnecessary treatment that could hurt you. So I think you need to know for sure why the first opinion is incorrect, or at least avoid accepting the second opinion blindly, because the first doctor won't be there to push back.
Of course, I know nothing is ever certain here. Still, having two opinions or more data can be valuable, but only when whoever makes the final decision can actually use that information: detecting any bias and deciding with a good balance between risks and rewards.
Yes, this is a difficult decision - if conflicting treatment advice is provided by the two doctors, how do you decide between them? It's not necessarily the case that the second doctor is correct.
Of course, if additional tests are done by the second doctor and new information is uncovered, that helps.
My ex-wife was diagnosed with thyroid cancer, and the first doctor said that urgent surgery was needed and both thyroids need to be removed.
She obtained a second opinion from a well-known oncologist, who said that only part of one thyroid needs to be removed, and it wasn't so urgent.
Because everyone wanted to believe the second doctor, that was the option she went for.
This was a very expensive doctor. Shortly after the surgery, he notified her that, in fact, the cancer had spread to both thyroids, and the other one had to urgently be removed as well. This led to double the medical bill, opening up her neck twice, and all the accompanying inconvenience of two surgeries.
It was a strange situation where an incorrect assessment by the doctor directly led to that doctor making more money.
Also, it highlights the tough decision in terms of how you decide between two conflicting opinions if there are no additional diagnostic results to assist.
There is only one thyroid ... presumably you're referring to the two lobes.
There are generally clear discriminators determining whether a lobectomy or total thyroidectomy is called for. What is missing here is the detailed discussion with the two doctors of exactly why they were recommending their course of action and what attempts were made to reach consensus. "everyone wanted to believe" is not the way to go about such things ... but there's a good chance that the evidence favored the less radical course. A lobectomy has considerably less radical consequences and so is strongly preferred if a total thyroidectomy isn't indicated. But it's not uncommon for the pathology report of the removed lobe to indicate high-risk features that call for a "completion thyroidectomy", which is what your ex-wife had. It's not some nefarious conspiracy to make more money.
Thank you for the corrections and clarifications. It does still support the point that it can be hard for a layperson to make a call on which opiniom to adopt.
With "everyone wanted to believe" I was referring to the patient and family.
It was (is) difficult to get appointments with these doctors as they are fully booked months in advance and there was no opportunity to consult with them again or get them to discuss the case with one another. Hence the decision had to be made with the information that could be remembered from the consultations. (These days I always record all doctor's consultations for future referral, as memory / recall is of course notoriously bad.)
wouldn't they do that at the time of the surgery as opposed to finishing one surgery and then doing it all over again later?
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The difference is going to a national cancer center.
My late wife was treated for metastatic melanoma at MSK. Their approach is to have clinical teams and a tumor board that are assigned patients with related cancers. They are seeing many patients and there’s a warm hand off between specialists. Your radiation oncologist, medical oncologist and surgery / neuro specialists are on a team and know each other and are often familiar with the cases. In my wife’s case the community oncologist was wonderful, but he was a sole practitioner for this particular cancer.
In the second opinion scenario, they get to use that experience and caseload to look at a case with some perspective. Your community oncologist likely works on a small team and may not have the luxury of time and exposure to trials, etc.
Think of it as a second set of eyes.
Do you get a 3rd opinion and go with the consensus? Genuinely curious what people think.
Between November 2024 and January 2025, I visited liver surgeons at 4 different hospitals in 4 different states and got 3 different opinions on what was the correct next step for my cancer treatment.
I don’t regret it.
How did you choose who to listen to? The 2 that agreed?
I broke my leg at the edge of the Fibula bone. 4 Orthopedic specialists gave me 3.5 different opinions with different and conflicting recommendations for treatment.
So, unless the first two opinions are completely identical - yeah, definitely get the third. Better to go for people with slightly different specializations if relevant.
I've had a couple of second opinions for far less serious stuff in recent years. In both cases the original doctors suggested major surgery pre-emptively, even though they were very different types of thing.
In the first case, I decided to talk to an expert in the particular area who then ordered different tests. These indicated the issue had actually gone away completely, and I avoided surgery as a result of those.
In the other, a grade 2 ACL tear, it was less clear-cut, but I felt like the explanations given by the second doctor as to why he'd recommend against surgery were clearer and made more sense to me.
I'm glad I got both second opinions and the first case in particular, made me much more likely to get second opinions in future as well as more confident about doing so.
Yes you get a 3rd, 4th, 5th opinion! Until you understand what the consensus seems to be. This is serious stuff.
I understand that insurance is not your friend and you must advocate for yourself in the modern healthcare landscape, but if appointments take months to get to because everyone is overbooking limited oncology specialists to get their second and third opinions, at what point is this counterproductive for wider healthcare outcomes?
Particularly with cancer, when earlier treatment is better.
From the perspective of both individual patients and the system as a whole, the best long term potential lies in more accurate and widespread cancer screening. If it can be detected earlier then treatment becomes much easier and cheaper. The liquid biopsy assays available today still aren't accurate enough to recommend for everyone but they should improve. In a few decades I expect adults to be getting them every few years.
After reading this thread it seems to me that differences in doctors are so vast that multiple opinions are necessary to ensure good care.
If doctors improve (maybe by using better analysis tools), hopefully it will no longer be necessary.
"Never go to sea with two chronometers; take one or three."
If think for a moment I'm sure you can come up with a solution.