Second Opinion A Necessity

Richard Bloch

On May 7, 2001 on ABC National News Peter Jennings stated, “In cancer, a second opinion should be more than just an option.” The following evening his report went in depth reviewing the study at Johns-Hopkins about the alarming figures of individuals treated with surgery or radiation for prostate cancer who did not have any cancer and the one in 5 cases of all cancers wrongly diagnosed or staged, resulting in improper treatments being given.

My opinion is that he was pointing to the tip of the ice berg. He is ignoring the mass of the problem. The fact is that very rarely is cancer ever diagnosed by an oncologist. It is diagnosed by an internist, optometrist, gynecologist, urologist, dermatologist, GI, GP, etc. One treatment often precludes the proper treatment from being given later. Doctors are humans and could make a mistake.

Nothing is intended to be negative to physicians. We are all alive only because of physicians and research, but it is a fact of life that physicians are human beings. As such, they might not see and recognize all the factors, they can not have total knowledge, they could make an error in judgment or they could make a mistake. “To err is human!”

Cancer is an extremely complex subject and requires the knowledge and expertise of numerous specialists to arrive at the correct treatment options. One physician speaking for another is never a good idea. Even in a specific field, some do not believe possible what others can readily accomplish.

My own case is an example. 23 years ago I was told by the outstanding thoracic surgeon in my home town that my lung cancer was terminal, I had 90 days to live and nothing could be done. He would refer me to anywhere I wanted but he assured me that he knew everything anyone did. 5 days later another doctor in another city said I was a very sick boy and he was going to make me a lot sicker but he was going to cure me so I could work for cancer.

Our latest project and by far the most important one we have tackled is “BLAST Cancer”. It is a project to see that every newly diagnosed cancer patient automatically receives a second opinion from a medical oncologist, radiation oncologist and surgeon (if their specialty is applicable to that type of cancer) prior to any treatment and within 7 days of diagnosis. It is vital that it be universally applied to every case of cancer diagnosed because the individual told there is nothing that can be done or they need surgery immediately is precisely the one who needs the prompt second opinion. To make it elective or voluntary would defeat the purpose. It would get the tip but not the ice berg.

The Institute of Medicine has done an excellent service in comparing medical practice to aviation in an attempt to reduce medical errors. Flying is relatively extremely safe today because any time there is an accident, no effort or expense is spared in trying to find a basic cause of the accident so it will not be repeated. Whether it is an act of God, a mechanical malfunction or a human error, the ultimate cause is located and steps taken to avoid it happening ever again. This same effort should be applied to medical practice so that lives are not unnecessarily lost.

One obvious comparison that has not been addressed is in the fact that in small jet aircraft carrying passengers, two pilots are required. Any qualified pilot is capable of flying a small jet solo. But the problem arises when anything starts to go wrong, it compounds so rapidly that a second pilot is required. Not so in small propeller aircraft. One pilot is deemed sufficient, even when carrying passengers. Why? Because things don’t happen as rapidly. This principal should be applied to medicine.

When an individual gets cancer, they must be treated promptly, properly and thoroughly if they are to have a chance of beating it. Because cancer grows geometrically, if they are not treated correctly the first time, often there is no second chance. And cancer is an extremely complicated disease with numerous modalities of treatment given in various degrees and order. Often it requires a team of specialists to accomplish what an individual physician doesn’t believe can be done. A second opinion promptly upon diagnosis and prior to any treatment should be standard procedure.

Not so with a broken bone, allergy or nearly any other illness. If it is not corrected properly the first time, it can be treated later in a different manner and corrected. If the first medicine didn’t work, a different medicine could be tried. If the first surgery didn’t produce the desired results, the surgery can be repeated. But with a diagnosis of cancer, if the first treatment isn’t correct, the patient is generally dead!

In most professions, a mistake usually costs someone a few dollars. In cancer, a mistake means a life as there is generally only one chance to succeed. As long as physicians are human beings, second opinions for cancer patients are a necessity.

Many more details are available at Let’s hope and pray that Peter Jennings starts a wave to reduce medical errors by making second opinions more than just an option.

Free second opinion and peer referral (800)433-0464

Pathology Second Opinions

Annals of Surg Onc, 12/02

Pathology sites
Interobserver Variability: Pathology

Euro J Cancer, 10/03

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