How to Deal with a Medical Crisis

Medical experts answer more than two dozen key questions—about second opinions, clinical trials, the limitations of insurance, and other significant topics—to help patients map a road to recovery

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5.
What if the first and second opinions disagree? Should I get a third? Where does it stop?

• Get a third opinion when the first two don’t agree. Opinions should point you in a clear direction for treatment. “The only time a third opinion is helpful to me is when the two opinions are really conflicting,” says Stephen Nigh, a radiation oncologist at Northwest Community Hospital. “When it starts to go to the fourth or fifth opinion, it becomes a disservice to [patients]. Health-care decisions are very complex. At some point you do have to trust [your doctors].” When you are no longer receiving new information, there’s not much value in seeking more opinions.

If you do decide to seek a third opinion, find a doctor who is a thought leader in the field. “If you have differing opinions, you should seek out a real academic medical center,” Jeevanandam says. In Chicago, the main academic hospitals are the University of Chicago Medical Center, Northwestern Memorial Hospital, Rush University Medical Center, and Loyola University Health System.

At the extreme, some patients avoid addressing their medical crisis by continuing to seek opinions. “It can go too far at times,” Gauthier says. “The person that keeps wanting to get one opinion after another, putting off starting treatment, is actually doing themselves harm.”

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6.
Will my insurance cover a second opinion?

• Different insurance plans have different arrangements for second opinions. Some plans will require approval before getting an opinion from an out-of-network doctor, some plans require approval before a second opinion from any doctor, some require a referral, and so forth. Before you make an appointment, read your plan’s subscription manual or call the insurance company to find out.

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7.
How do I find a doctor for a second opinion—or for a first opinion, for that matter? And how do I know if a doctor is a good doctor?

• Act like a journalist: Ask around. Call your doctor. Most doctors—including your own—will gladly give referrals to specialists. Or call the hospital’s referral lines and ask what doctors are experts on your illness. A number of groups publish lists of doctors and their specialties. Hospitals’ Web sites often have physician-finder tools to identify their resident experts on particular illnesses. If you have cancer, the American Cancer Society hotline (800-ACS-2345; cancer.org) will provide a list of treatment centers in your area. In connection with Castle Connolly Medical Ltd., this magazine regularly publishes a list of top doctors by specialty in the Chicago area, most recently in January 2008. We’ve reposted that list at our Web site Enter the code CHICAGOMAGDOCS when prompted at the site. (The magazine plans to publish a new Top Doctors list next in January 2010.) In general, word of mouth, whether from other patients or other medical professionals, is still the most common way of finding a doctor.

“In all honesty in this instance, I would say call Steve Rosen,” says Rosen, the head of the cancer center at Northwestern. “I’d say in a given week I handle, on average, maybe 30 or 40 referrals that I’ll say, ‘This is who I think you should see in our system.’ ” Rosen adds that he will often refer people to someone else who can make a referral better than he can. Doctors are part of a network; you just have to ask them to tap into it.

Publications and Web sites evaluate doctors and hospitals. The same company that provides data for this magazine’s Top Doctors, Castle Connolly, publishes the book America’s Top Doctors. The magazine U.S. News & World Report annually publishes a Best Hospitals issue that ranks hospitals by specialty. Subscription-based Web sites HealthGrades.com, AngiesList.com, and Checkbook.org evaluate individual doctors.

Some doctors warn patients about the limitations of these resources. “You can’t really just go to Web sites, stats, and numbers,” Jeevanandam says. “A lot of the Internet stuff can be manipulated or misleading.” He cites patient volume as an example—a low number looks discouraging, but it could mean the program takes on tough, time-consuming cases. Ultimately, it’s best to use these published reports in combination with recommendations from your doctors.

And don’t underestimate the importance of getting along well with your doctor. “I think that that’s the single most critical issue outside of being knowledgeable about the disease—that [the doctor is] available and empathetic and willing to be a good listener,” says Rosen.

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8.
Is it worth getting an opinion from a well-known doctor at a hospital outside of Chicago?

• Except in rare cases, no. “There’s very little that would be added that you can’t get from one of the academic centers here,” Rosen says. Medicine is collaborative; doctors keep up with the thought leaders in their specialty areas and consult them in cases of uncertainty. “There isn’t a thing that’s out there that a [New York’s] Sloan-Kettering [Cancer Center] person may be saying that we don’t know about,” Rosen says.

An uncommon disease, procedure, or set of conditions might justify a trip outside the Chicago area. “The question about whether to leave your local region is: Is there something someone else can offer?” says Thoralf Sundt, a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota. 

Very rare illnesses have fewer experts. As big and medically rich as Chicago is, it can’t provide for the needs of every “zebra,” as doctors call unusual diagnoses. If your case is a zebra, you will find out from your doctor. When you are looking for referrals for a second opinion, ask, Where can I find a doctor with specific expertise on my condition?

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illustrations: Harry Campbell

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