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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comments
5 years ago
Posted by Anonymous

I purchase Chicago Magazine from the news stand nearly every month. On the cover page for this article in the magazine, it says "To access Last year's Top Doctors List, visit chicagomag.com and enter the code chicagomagdocs".

And, on the cover of the magazine, it says "TOP DOCTORS Get Access to our List see p.61".

This is very misleading, as your web site does not allow access to the list, even with the above stated code, unless you are a subscriber. Is that correct or am I doing something wrong?

5 years ago
Posted by Chicago Magazine

We're having some technical difficulties with the passcode. If you can please create a free online account at https://www.chicagomag.com/Chicago-Magazine/My-Account/ you'll be able to access the Top Docs list right away.

We apologize for the difficulties.

If you have any questions please email us at feedback@chicagomag.com

5 years ago
Posted by eworon

I am entering "create an account"

5 years ago
Posted by debrasue

I created an online account and I still can't access the doctors list.

5 years ago
Posted by AMS

Creating account

5 years ago
Posted by Bill O.

If you're having problems creating an account, feel free to contact me at boakes@chicagomag.com


Bill Oakes
Manager, Chicagomag.com
boakes@chicagomag.com
312-832-6745
Chicago Magazine | 435 N Michigan Avenue, Ste 1100 | Chicago 60611

5 years ago
Posted by meggie

I ordered the top docs magazine for the list of top docs because my son moved to Chicago. I was trying to find out what docors were good. I paid seven dollars to have the magazine sent to me in Michigan and I have not one doctors name. I read the above comment and I also can't access the names. I get Hour Detroit and they always have the list in their magazine and I thougt you did the same thing.

5 years ago
Posted by ellenw

I have a subscription to Chicago Magazine, but cannot access the top doctors'list. Please tell me how to proceed. Thank you. Ellen W.

5 years ago
Posted by Helen

I also tried to access the list and am having no such luck. Why can't you just publish it every year like you used to. I found it very helpful and have saved these magazines for years. I am now trying to access the list. Are you going to fix this problem?

5 years ago
Posted by katiecooke

hello

5 years ago
Posted by Lisa M.

Did anyone get the list of top doctors to work? If so plz tell me how.

5 years ago
Posted by Chicago Magazine

Per our arrangement with Castle Connolly Medical Ltd., we have removed our Top Doctors list from chicagomag.com. We posted that list, first prepared exclusively for Chicago’s January 2008 issue, as a supplement to our January 2009 feature How to Deal with a Medical Crisis. Castle Connolly allowed us to keep that list up on our Web site for only three months.

That doesn’t mean you no longer have access to the list. While supplies last, copies of the January 2008 issue are available from Chicago at our customer service number: 800-999-0879.

Please see http://www.chicagomag.com/topdocs for more info.

Thank you.

4 years ago
Posted by Cathyculben

I had a subscription and do have the January issue for 2009. I thought the magazine listed topdocs. Now that I have an emergency, I notice that the list has to be accessed online. I have had no luck accessing the list online. Can the list of topdocs be emailed to me? If not, how can I access the list. What is the point of not including the list in the magazine?

4 years ago
Posted by clay

I would like to access the site of Top Doctors in Chicago as in Chicago Magazine

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