Second opinion, or Do you need a second opinion?

What is a second opinion in oncology, what is the meaning and why to get it - we talk about it with the famous surgeon-oncologist, candidate of medical sciences Yuriy Kondratskyi.

Yuri Mykolayovych, what is a second opinion? What is behind the most common term Second opinion?

Second opinion is a modern international medical term that translates literally as "Second opinion". It means getting an independent expert opinion on the already established diagnosis — from another specialist from another clinic. This is necessary to exclude errors in diagnosis and, as a result, in treatment. After all, incorrect treatment can cost a person his life, especially when it comes to oncology.

People make mistakes every day, and doctors are not immune to them either. This is why more and more patients are getting a second opinion after diagnosis. Whether your doctor is recommending surgery, diagnosing cancer, or detecting some other medical condition, getting a second opinion has undeniable benefits.

These benefits include everything from confirmation and peace of mind to a new diagnosis and a different treatment plan. Yes, it may require additional costs, but in the end it saves money on unnecessary drugs and procedures, preserves health, and often saves lives.

Errors in the diagnosis — our, Ukrainian, problem or common to all countries?

This is a global problem and, according to research, it does not depend on the level of development of medicine. It would seem that for countries where this level is high, the issue is not relevant, but... data published in one of the most authoritative medical publications, the British Medical Journal, say otherwise.

According to the results of studies conducted by the largest clinics in the USA - MAYO and Johns Hopkins University - when checking diagnoses, errors were found between 30% and 60%. That is, in difficult cases, doctors of ordinary hospitals in the USA made a mistake in the diagnosis of every second patient (!). Unfortunately, oncological diagnoses are always difficult.

What are the errors related to?

There are many reasons. Clinics do not carry out recommendations regarding the amount of necessary examinations clearly enough and, as a result, make inaccurate or incorrect diagnoses. And in the case of oncology, it is very important! Often there is an underestimation or, on the contrary, an erroneous overestimation of the stage of the disease, which critically changes the tactics of treatment and often costs patients not only lost health and money, but also their lives.

Much depends on the experience of doctors, the technical capabilities of the clinic, and even on the behavior of the patient. The human factor, unfortunately, plays a huge role. For example, the results of research by British scientists have been published, which confirm that more aggressive patients often receive an inaccurate diagnosis, because the doctor subconsciously tries to "get rid" of such patients faster.

Even so?

This is understandable. A doctor is a person just like everyone else. When working with an aggressive patient, he feels psychological pressure, he is in a hurry, and under the influence of adverse factors, he may make an inaccurate diagnosis. Moreover, it is not even about Ukraine, but about such countries with developed medicine as the USA, England, Germany, Israel. Insurance companies that pay for people's treatment see what's going on and provide objective data.

What is the main point of getting a second opinion?

It is precisely in the fact that the correctness of examinations and the correctness of the diagnosis is checked. When two authoritative opinions coincide, the probability of error is dramatically reduced. In fact, if the patient receives two identical results, he can be sure that an accurate diagnosis has been made, the stage of the disease has been correctly determined, and the optimal treatment plan will be offered. This is the truest path to follow.

It happens that a person is uncomfortable, it seems that he will distrust his doctor, and the doctor will treat him worse.

It cannot be "inconvenient" when the price of the question is life. I myself recommend doing so if the case is complicated, or if I see that a person doubts. I advise you to choose a reputable clinic, take all the documents and get a second opinion. As a rule, a patient who heard such advice from a doctor and went to another hospital for consultation, returns to his doctor. Then he appreciates professionalism more and understands that the doctor cares about his health. On average, this happens to me two or three times a month. This strengthens the trust between the doctor and the patient, affects both the authority of the clinic and the authority of the doctor.

A second opinion and a multidisciplinary consultation are tools that allow not only to reduce the probability of an error, but also to eliminate the negative aspects associated with making a diagnosis. Moreover, it is a multidisciplinary commission, which includes doctors of various profiles - oncologists, surgeons, radiodiagnostics and radiation therapists, chemotherapists, pathologists, etc. - Mandatory component when developing a treatment plan.

That is, the final treatment is not prescribed by one doctor, but by a council of specialists?

Yes. This approach meets world standards, and this can be explained because today it is impossible to cover all modern methods alone. Oncology is one of the rapidly developing sciences; international protocols are adjusted every three months with the advent of new treatment methods. Oncological treatment is a whole complex of methods. And no matter how experienced a doctor is, he can know all the nuances, he has no right to assume the functions of a god and make decisions alone. After all, the only way for a patient to get a chance for recovery is through modern treatment methods.

If the patient, for some personal reasons, still does not want to inform the doctor that he is getting a second opinion?

There is no problem. The patient can request a second opinion anonymously. It is not necessary to notify the clinic in which he is currently undergoing examination or treatment, if it is essential for him. When receiving a second opinion, the patient is given a conclusion with the recommended scope of examinations or confirmation of the diagnosis that was established earlier. He may or may not show it in the clinic where he is being treated. It is his choice, and each person can look according to personal circumstances.

In difficult cases, when the opinions of doctors of two clinics differ, it is reasonable to get a third opinion, that is, to turn to an arbitrator - to a third clinic. It is best if it will be a leading clinic of the country or an international center, where doctors with extensive experience work and modern equipment is concentrated. As an example, if one diagnosis was made in the district hospital, and another was made in the regional or oncology dispensary, then it is logical to contact the specialized oncology center of the highest level with the results of the examination for a final decision.

If it turns out that there are any gaps in the examinations or doubts about the diagnosis, the patient undergoes additional studies. After that, his case, according to international protocols, must be conducted through a multidisciplinary council. As I mentioned, getting a second opinion is critical in oncology. A person must be sure that he is on the right path and has done everything for his recovery.