Many of the calls and emails we receive at NAFC evolve around the anxiety that consumers feel over whether to seek a second or even third opinion from a different doctor. At NAFC, we work hard at reassuring them they are not betraying their doctors, when they ask additional questions or even when they seek additional opinions from others. Some consumers even express concern they will be mistreated purposely by their doctors if they are perceived as being disloyal. Such anxiety only adds to the angst patients already feel over their symptoms and their options for treatment. Myths abound among the public, particularly about incontinence.
The best time to seek multiple provider input is on the front end as diagnosis is being determined, when a care plan and a course of treatment are being discussed and formulated. Depending on how widely treatment regimens may vary and how serious and permanent the adverse side effects might be, it may be advisable to seek additional diagnostic opinions even in circumstances where a patient feels happy with his or her doctor. The more rare the circumstances, the more this is true, especially where treatment options are still relatively new and underdeveloped.
Moreover, in continence care, there is a wide variety of clinical disciplines involved in the care equation. Each of these categories of providers approaches symptoms from a slightly different perspective and certainly with very different training, often with a different tool box of options to offer. And one may be more appropriate than another at one stage versus another in the timeline of your experience with symptoms of bladder and/or bowel control problems.
In recent years, there has been a lot of research on whether the volume of procedures a surgeon performs - or even that a hospital undertakes - has a direct bearing on outcomes. While the data remain somewhat mixed, the general direction of research findings is in support of the volume=quality equation. Much goes into the right equation, so look beyond just volume to learn about the range of experience your doctor has, the type of training, certification, etc. This applies not just to doctors but nurses and therapists as well.
Another increasing reason for seeking additional opinions has to do with the aging population now living with multiple, chronic illnesses. Today, we face the risks of drug interaction and the tradeoffs necessary in treating one condition or disease over another. While surgery might be an ideal option for a patient with severe stress urinary incontinence, that same patient with obesity, advanced diabetes and congestive heart failure might present a different set of factors for all the doctors involved.
A final reason for sourcing different opinions has to do with cost itself. Doctors have a limited sense of the full cost of any treatment plan they are recommending, in part because they can't possibly be current in their knowledge of all the different health insurance plans and coverage a patient might have. Some patients have high deductible plans, while others have more traditional indemnity plans. Some patients have government plans such as Medicare and others have no insurance whatsoever. This can have a profound and important impact on diagnostic and treatment options. Doctors and patients do not have a history of easily engaging in conversation on this topic. In fact, doctors traditionally have shunned discussions about money as if it tainted their medical judgment. However, times have changed!
Lastly, there is human chemistry itself. A person's ability to communicate effectively and comfortably may well differ from one doctor to the next. Only the patient can be the judge of when the communication is incomplete. And only the patient deserves to make that judgment.
So the next time, you feel in your gut that your doctor hasn't heard you or isn't responding as you think he or she should, take a time-out. Seek out another opinion. Find another qualified expert - through a friend or family member, through the healthcare plan providing insurance, or through a patient advocacy group like NAFC if your problem is bladder and bowel control - so that you're satisfied with the ultimate treatment regimen and care plan.
National Association For Continence (NAFC)
Published On: November 30, 2009