When a 2008 biopsy revealed one tumor in Dick Haughey’s stomach and a CT scan exposed another in his lung, doctors at a west suburban hospital told him to prepare for the worst.
“I was talking to people about donating my body to science,” said the 73-year-old.
His son, though, wasn’t ready to give up and urged his father to seek out a second opinion. The elder Haughey went to Rush University Medical Center, where, after a battery of tests, clinicians reached a different conclusion: This wasn’t one ravenous cancer, starting in the stomach and invading the lung, but two distinctively separate malignancies.
In one fell swoop, Haughey had his death sentence reversed to a far more optimistic prognosis. “I felt like I got my life back,” he said, from his Clarendon Hills home.
When to get a second opinion is confusing terrain for most patients. If you like and trust your doctor, why not just abide by the original decision — especially when you already feel as if your world has been turned upside down?
Doctors often encourage patients to seek out another consultation, especially if it’s a disease that is difficult to diagnose, has inconclusive test results, multiple treatment approaches or when the recommended option could have permanent consequences, experts said.
“We all come from our own training backgrounds … and sometimes we have little blinders on,” said Dr. John Losurdo, a gastroenterologist and member of Haughey’s treatment team at Rush. “The more eyes you have on a patient, the more viewpoints you hear … and the more effective you can be.”
Getting additional input can be useful for many reasons — especially with all the advances in scientific knowledge and technology that have occurred in the past decade, offering fewer side effects and shorter recovery times, clinicians said.
“Not everyone is up to date on the latest procedures, which might be less invasive,” Losurdo explained. “Doctors are not going to recommend something they haven’t done a lot of … or they’re not comfortable with, so you often have to seek those out.”
Sometimes, health care professionals don’t even need to see the individual. The Cleveland Clinic offers an online program called MyConsult, which for $565 will review a patient’s tests, scans, and lab results for more than 1,200 diagnoses then provide a report through the secure online portal that can be shared with their physician and be treated locally.
The kind of errors Haughey experienced are not uncommon, according to Dr. Jonathan Schaffer, an orthopedic surgeon and managing director of eClevelandClinic. In approximately 75 percent of their MyConsult cases, the diagnosis is correct, 15 percent additional tests need to be done and 10 percent were “flat-out wrong.”
When it came to a treatment plan, there was even more room for interpretation. Some 36 percent of the cases matched the Cleveland Clinic recommendations, while 47 percent call for minor or moderate changes. In 17 percent, the physician teams who reviewed the file disagreed with the current treatment regimen.
Many health insurers cover the cost of a second opinion, according to Susan Pisano of America’s Health Insurance Plans, a national trade association representing the health insurance industry. In very complex conditions, a third opinion may in some cases be covered, as well.
It’s not that doctors at community hospitals are poorly trained or less conscientious, say experts. It’s just that they do not see the same volume of cases as those at large academic hospitals or specialty centers.
“The average oncologist might just see a few head and neck cancers a year — which can be very tricky to diagnose,” said Dr. Ezra Cohen, associate professor of medicine at University of Chicago Medicine, who sees about 100 cases annually.
But even within the big four of cancers — breast, colon, lung and prostate — there can be variations that would call for more consultations. Within a treatment plan, someone might advocate for taking a small section of the X, while someone else might advocate for total removal of Y, which would be the surest way to prevent a recurrence.
Often, patients worry that they’ll offend their doctor or violate some kind of professional etiquette if they go elsewhere, but calls to a half dozen Chicago specialists were unanimous in saying they welcome such discussions. Patients shouldn’t be afraid to ask: “How many people have you treated with my disease? What kind of results have you had with a particular treatment?”
“If (doctors) are uncomfortable with any of those conversations, that would set off a red flag,” Cohen said.
However, it is possible to get overwhelmed by too much information, practitioners said. Cohen related a story about a patient with a very aggressive of thyroid cancer, who came to Hyde Park seeking a fourth opinion. “In those six weeks, his cancer was growing. You can waste precious time and resources.”
Ultimately, it gets down to a trusting relationship.
“If you don’t feel warm and fuzzy, you really owe it to yourself to go somewhere else,” said Haughey, who readily admits he would not have gone to Rush if he hadn’t been prodded by his son.
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In Haughey’s case, the Rush team wasted no time getting him into surgery. In January 2009, he had the top lobe of his right lung removed, followed by 13 weeks of daily radiation and chemotherapy.
Five months after the lung surgery, he had his stomach removed. A new pouch was created, allowing Haughey to eat most foods, albeit in much smaller portions.
Along with learning to eat differently, Haughey came away with more appreciation for prayer, friends and family and a positive attitude. Last year, he got a clean bill of health.
“Just knowing there was a plan brought tremendous peace of mind,” he said. “You don’t think things will ever get better, but I can tell you … life will be good again.”