When (and How) to Get a Second Opinion
Patients often shop around for care, which can result in conflicting diagnoses and treatments. The patient is then left with the confusing task of sorting out who to believe and trust with their care. In this interview with Jeff Greenwald, Kevin R. Stone MD discusses when it’s a good idea to get a second opinion—for any surgical orthopaedic procedure you might be considering.
Let’s begin with your basic philosophy on second opinions.
Dr. Stone: Orthopaedics is a beautiful science in that it is both primitive on one hand and evolved on the other. Almost every procedure in orthopaedics can be made better. So if you, as a patient, feel confident that your surgeon is at the leading edge of their field—someone who really understands the pros and cons of each technique, and is willing to discuss them with you—then I think you should be able to move forward confidently. And it helps if you develop a good relationship with them; one that breeds confidence in both their care and their thinking process.
If on the other hand, there’s a barrier to exploration, a lack of curiosity, a frustration with providing answers or engaging in discussion…Well, in that case, I think it’s important to get other opinions.
You seem to be implying that orthopaedic surgery is a bit of a moving target.
Dr. Stone: Every procedure is unique. Each patient is unique. And I think any surgeon who says, “This is a standard procedure, I do it the same way every time” is missing out on the opportunity to improve the field and to customize what an individual patient actually needs. Even something as common as a torn meniscus, which happens in the U.S. about one million times a year, can be operated on multiple ways—depending on the presentation, the pattern of the tear and health of the tissue, the health of the patient, their goals, and a thousand other factors.
And so, applying brainpower to the problem is the first, most important thing a patient should seek. You know, when patients are asked what they seek out in a doctor they will often say, “I look for someone who’s kind or caring or compassionate; someone I can talk to.” Those are all wonderful traits, but they’re not the primary traits you want in the person who is operating on you. The first trait you want is someone who is curious and smart—and has extraordinary technical skills. After that, being caring and affable are wonderful traits and important to good patient care. But if they’re not smart enough to be creative, or they’re not technically facile, you’re not in the best hands.
Let’s say someone’s on the verge of a total knee replacement, or some other orthopaedic procedure. Are there a few specific questions that someone should ask the alternate doctor?
Dr. Stone: What is my diagnosis? What are the options for treating it? And how, in your hands, would I get the best outcome?
But can most orthopaedic surgeons reply to these questions in a way that’s understandable to the lay patient?
Dr. Stone: Well, I don’t think most orthopaedic surgeons speak Greek! Most orthopaedic problems are fairly practical, in that patients understand what’s going on and can actually feel what the problem is—as opposed to, say, some cancers. In orthopaedics it’s an injury or arthritis, a limitation or a break, or a tear or a rupture of something. And you the patient usually know exactly what is wrong, but you don’t know the best ways to fix it. I think that the language of orthopaedics is actually fairly commonplace and understandable to most people.
What it all comes down to is, how do you decide who to trust? Suppose you get two different treatment options. How do you decide which one is the best?
Dr. Stone: The point is that there will always be different opinions and varied options for treating the same problem. That’s what’s interesting and challenging about orthopaedics. And you have to figure out—in part for yourself and in part with good guidance—which option intuitively feels right to you. Because every opportunity to help make a patient better is also an opportunity to make them worse. And if the procedure that you’re choosing doesn’t work well, you need to know in advance what the surgeon’s backup plans are. If it doesn’t work, how are you going to get out of this? How are you going to save your knee or your joint? What’s the next plan? And just as important: How do we create a lifetime plan? Not just a plan to fix something once, in this minute, but going forward for many years to enjoy a fit and athletic life?
These sound like good questions to ask getting into any relationship!
Dr. Stone: Exactly. My feeling about patient care is that it’s a lifetime relationship. The more I can inspire a patient to see themself as an athlete in training and not a patient in rehab, the better they—and I—will do.
And the more a patient checks in with me, and with our rehabilitation, strength, and conditioning team—to see how they’re doing, and how their fitness level is, even when they don’t have a problem, just in order to optimize their fitness and health—the better a relationship we develop with that patient over time. And so, yes, I think it does compare to a lifelong “dating” relationship. And it’s one that can be a lot of fun.