Ep 33 Second Opinions in Healthcare

Heather Johnston  0:00  
This is Doctor Patient, a podcast that examines all the aspects of the patient-provider relationship. I'm your host, Heather Johnston, MD, a real-life doctor and patient. I'm going to talk today a bit about second opinions in healthcare. This is when you see one doctor for something, and then see a different doctor for the same problem to get their take on it. Usually, patients are seeking second opinions after they've had a serious diagnosis, like cancer, as an example, and they want to see if treatment recommendations are different from one place to another, or they have a rare and unusual problem and want to seek out an expert in the related field, or maybe because they have an ongoing problem that's not being figured out, meaning it's not really used for smaller or everyday things, like a sore throat, or for which blood pressure medication is being prescribed. The process of getting a second opinion is sort of like the wild west, there's no exact procedure, and it seems to occur a bit differently between institutions and providers. Sometimes it goes seamlessly, and oftentimes it doesn't. Sometimes it doesn't cost you anything, and sometimes it does. Sometimes it's convenient, and sometimes it's not. On top of that, second opinions often come at a really inopportune time because you're more likely to seek one out while you're in the midst of a potential health crisis, so why do it at all? Well, for many kinds of illnesses, there are accepted standards of care and standard treatments, which most doctors are all using. For example, if I line up 10 pediatricians treating a simple ear infection, hopefully at least eight are going about it the same way. If you have a severely arthritic knee and need a replacement, most places are going about that the same way, but this isn't always the case for serious illnesses or rare illnesses where there isn't as much data about what to do. The reason why comes down to where doctors are getting their treatment guidelines from, and how they interpret those. With medical research exploding at a breakneck pace, and with the rise of AI, it's frankly hard to keep up with it all. And new advances and discoveries are happening all of the time. This means that, instead of consulting time-tested treatments, sometimes doctors are reading current research and interpreting it to make treatment plans in real time. This isn't a bad thing, but it does open up the possibility that different doctors will interpret those research studies and that data differently, and so you might hear different opinions about what to do from different doctors for the same disease. I've been through this process myself, and for this episode, I'll be bringing in two other people to join me, Mia and Joby, who have both also had experience in getting second opinions for an illness. Our conversation was wide-ranging, so I'm going to give you a summary of what their diagnoses were, so that you can keep it in your minds as you hear their stories in more detail. Mia was diagnosed with breast cancer in 2010 and had to seek a second opinion right off the bat for several reasons. Joby has had a challenging few years, as he was diagnosed with three different cancers in the last five years, if you can believe it, bone cancer in his hip in 2022 Hodgkin's lymphoma in 23 and something called follicular lymphoma in 24 He sought a second opinion with the first one, the bone cancer, as it had already been misdiagnosed as arthritis a couple of years earlier, and because it was both a complex diagnosis and a complex treatment, and all of that drove him to seek out other options.

Joby  3:48  
I'm in a major city with big major medical centers. The second place I went with a very well renowned orthopedic oncologist with a lot of experience in surgical reconstruction of hips and femurs. The guy was a jerk, and he cut me off a bunch of times, and he's like, wait, you know what, he was almost a stereotypically arrogant surgeon, and he had very little sort of patience and time. He also cut Martha off. So, my wife, bad

Mia  4:28  
move. Yeah,

Joby  4:29  
you said, "Oh my

Heather Johnston  4:29  
god, nobody cuts Martha off,

Joby  4:32  
man. It's a good thing there is electronic separation here, because you know she. anyway, yeah, he was not a good guy, and or just I have no idea what I guess he's probably a pretty technically skilled surgeon, but I didn't want to deal with him.

Heather Johnston  4:51  
Yeah, technical skill isn't everything, right? Like, I mean, God, my God, like you're dealing with cancer, you need to be able to, you can. Connect with somebody,

Joby  5:00  
he also recommended a prosthesis that the third surgeon told me gently, but that he wasn't surprised that he had recommended that prosthesis, because he had developed it, or had had a hand in developing, so sort of interesting selling

Mia  5:17  
conflict,

Joby  5:18  
slightly,

Heather Johnston  5:20  
that feels icky.

Mia  5:21  
That's icky. I did not start with any intention of getting a second opinion, but kind of was led there by feeling a lack of confidence and care and coordination on the part of the people that I was seeing. I had gotten a diagnosis, as you usually do for breast cancer. You know, you have something suspicious, you get a biopsy, the biopsy reveals something, and you're like, oh no, this is terrible. What do I do now? And a lot of my understanding is that you know typically that person who gives you that diagnosis, usually like a radiologist, I guess, will then say, you know, see this surgeon, I've got this set up for you, so that happened. I was set up with that surgeon, and prior to me seeing that surgeon, I developed a rash, like a really horrible rash on my breasts, like, where you know where the biopsy was, and I sort of froak out and tried calling the radiologist and saying, like, I, this is terrible, because there's a kind of breast cancer that presents with a rash called inflammatory breast cancer, which is kind of game over for a lot of people, and so as I'm waiting to see the surgeon, like trying to deal with this, and I could not get to see anybody, nobody would see any, anybody, nobody would see me, nobody asked for pictures, you could send pictures at that time, and they were just like, just, you know, just put some Benadryl on it, okay, didn't help me mentally at all. Oh gosh, then I go to see the surgeon, and because I am me, and because my husband is my husband, we're both lawyers by training. We have a list of questions,

Heather Johnston  7:35  
just to interject, everybody should go in with a list of questions, regardless of if you're a lawyer or not, yes, continue,

Mia  7:42  
you would think you'd think I didn't think, I don't remember what those questions were particularly, but you know they felt important to me and my husband, and so we had our piece of paper in front of us, and I remember the surgeon came in kind of with a little bit of an entourage, like handlers or something, and they asked a few preliminary questions, and then she sat down. We were at a table, and we had our paper in front of us, and then started going through the questions, and she, she sort of put her hand up, and it's like, let me see if I can, and let me, let me just see if I can just talk to you and tell you, blah blah blah blah blah. So she talked and we listened, and then I started to look at the questions again, at which point, and I'm not going to get this in the right order, but she plucked the piece of paper out of my hand and looked at the questions herself and said, I think we covered this, I think we covered this, I think we covered this, and it just felt so like you're not worth my time, and you know, like I wasn't. I didn't feel like I was getting all of my answers, or I would have been like, 'Hey, great to meet you, bye. So there was that. So now that's two strikes.

Heather Johnston  8:58  
I'm just thinking it's interesting because all three of us kind of came to want a second opinion for different reasons. Mia, you were feeling sort of untrusting because it wasn't feeling right, they weren't really like giving you the right answer, and also they took paper out of your hand, which should never happen on this planet, and for me it was because I am a physician and I already had read a lot about it, and knew that thing, I knew that the treatments could be different place to place, so I automatically was already thinking about that. Joby, you felt like it was very complex, what you needed to go through, and complexity is scary, and makes you think, like, is it always done the same way.

Mia  9:43  
I will say, even though I, you know, was led, as I said, to getting the second opinion, I still wasn't, you know, sure that I would go with whoever that was. Right? Sure, when I started to commute. Educate with the second surgeon, I did it in was what was probably a really unorthodox way. Recall my rash, I was, you know, I had set up the second opinion, and I was supposed to see that second surgeon in like three or four days, I guess, still dealing with that. I was still completely freaked out, and you know, like in a ball on the floor, like, whatever this is. And a friend who was with me said, you know, why don't you write to the doctor, the new doctor, and see what you know what she says. So I was like, nothing to lose here, not great experiences hearing back from doctors, but I'll try it, of course. So I sent an email with a picture of the rash and said, we haven't met yet, you know, I'm supposed to see you in XYZ days. This is kind of really concerning to me, because of inflammatory breast cancer. Is there anything you can tell me to get me through this weekend? Yeah, and great. She wrote back, like, within an hour or so. She herself, she herself nice, and said, and said I've seen this before. It's probably a reaction to the chemicals that they used on the machine when you did the biopsy, but I understand it's scary. So, I will be ready to do a skin biopsy for you when you come in on Tuesday, Wednesday, whenever it was, and I was like, that's when I was like, she's really gonna have to mess up for me not to go with her. Yeah,

Heather Johnston  11:51  
that's amazing. That's amazing that she replied so quickly and replied herself. I mean, that really doesn't happen a lot for me. I was at one big medical center in where I live in Chicago, and then I was getting a second opinion at another big medical center, also in Chicago, and I'm not sure how much of this was me and my own, like I'm a very type A get shit done person, person, and so I knew it had to get transferred over. I think I didn't fully trust that the system would work exactly right, so I probably got more involved than somebody normally would, but you know, the records had to be sent from some suburban facility, so I called every single day until they told me it was done, and then I had to pick up the radiology stuff because it wasn't coming through properly. I think that I had four or five phone calls between the two places, and they just weren't getting it, so I was like, well, screw this, I.. I'm.. I have cancer, but I'm gonna get in my car and drive, you know, you can still drive when you have cancer, by the way. But I got in my car and I drove to one place, and I just waited there while they made the CD, and I drove it to the other place. But then, a couple weeks later, a couple days later, excuse me, I understood also that they needed the pathology slides. That's like when you're in an operating room and they're taking samples and stuff, they put them on slides, and then a doctor, scientist called a pathologist, actually looks at everything under the microscope, but those were literally my samples, so the new place needed those, so I had to go to the basement of the first place. I was totally lost, I'm like wandering around on there, even though I actually used to work there. I just never made it into the basement, and I was wandering around. I found the slides, I brought them, like, like being careful, like they were my third child, and transported them across the city to the new place, and that was my process of getting everything over there. And then I had to pay $672 for the second opinion fee that wasn't covered by in my insurance, that's just the fee that the second place charged for getting a second opinion. How did it go for you guys?

Mia  14:11  
I had a similar experience, Heather, where they told me, okay, you want to do that, you have to get this sent from here to there, and you have to get your slides and take them there. And again, I had the same exact response, like, "Hi, I have cancer. Do you think maybe someone else could take care of this? And you know, they're the,

Heather Johnston  14:37  
although, as a side note, it did give me something to do, by the way, like it took my mind off of it, because I'm just annoyed. Well, I was like annoyed at the process, which gave me something to be annoyed at, besides

Mia  14:48  
take a very long nap, so I was not interested, but I did get lost in, in the on the floor, where pathology was. Yeah, and I could not believe how, how kind of. Uh, old fashioned, it was. It's like a dude behind a desk with a bunch of, with a bunch of, you know, file cabinets and stuff behind him, and they're like, okay,

Heather Johnston  15:11  
did you have to pay for like any kind of fee like I did?

Mia  15:15  
I don't think I did. I did not.

Heather Johnston  15:17  
Curious,

Mia  15:18  
I did not. That I remember.

Heather Johnston  15:19  
Jobie, how did yours work,

Joby  15:21  
y'all? I'm feeling guilty. Mine was relatively successful, you

Heather Johnston  15:27  
for having such easy cancer,

Joby  15:29  
except for the completely asinine second surgeon. Mine was really easy. I, although there was a complication with the physical specimens and the slides, and when I talked to the second surgeon, he had not gotten them, even though they had assured me at the original place that they would be there and would be there in plenty of time, and even though the people at the first place, the surgeon I ended up going with, even though his folks are like, look, we'll follow up, and we'll make sure that this gets expedited. Long story short, he was, I think, able to see, I think, able to see some of my medical electronic medical records. I think I had to release some of those, but he wasn't able to see the pathology, and the slides hadn't arrived, but I didn't have to pay anything, um, I, and you know, maybe this is like surgeon clubbiness or something, I don't know, but they, they knew each other, all three, and the third, who was super cool, had trained with the first anyway, so I don't know if I was getting some professional courtesy pass on the on the fees or something like that, but

Heather Johnston  16:52  
I don't really know. I think some places charge for them and some don't. I don't know, and some insurances will cover that and some don't. So that was just my weird thing, so did you guys ultimately go with the person that you got the second opinion from? If yes, why? If no, why not?

Mia  17:11  
Joby's shaking his head, and he should be saying hell no. Okay, Joby, you didn't, because

Heather Johnston  17:18  
he sounded awful, and

Joby  17:20  
yeah, and seemed to be, you know, self-dealing, and it just awful, and I, I spoke to a third surgeon who was super nice and spent more than an hour with me and Martha, and I actually think much of my father's a surgeon too, and I phoned him in on

Heather Johnston  17:44  
this.

Joby  17:44  
I just couldn't, I couldn't hear, I couldn't process, so I ended up going with the first person, and yeah, and definitely not the second opinion, and the third, and the third person very gently he said, I'd love to have you as a patient, and we do good work here, and the particular kind of endo prosthetic attachment that they're doing to your femur, that is new, and they're doing it at that medical center more than we're doing that particular kind of attachment, and it's probably a good reason to go with them. We do the one that has been done forever, and it's very good, and it's very well sort of known, but the new techniques seem to be more promising longer term, so it was really back to back to number one for me.

Heather Johnston  18:47  
Yeah,

Mia  18:50  
I think you're going to probably be able to guess that I did go with the second opinion, you know. And I, it obviously it still sticks with me how responsive that surgeon was, and I, you know, I still try to see her every year. She has now treated my mother-in-law. My mother-in-law went straight to her when she was diagnosed with breast cancer, and she remembered me. But there was another reason, too, which was the plastic surgeon that was at the second place was also much more plugged in, and their whole approach was just so much more integrated. I wasn't sent off to go find someone else, and yeah, so I've been at that institution for all of my follow-up care for 15 years.

Heather Johnston  19:38  
So, Joby, it sounds like you didn't have a massive difference in what people were recommending. It sounds like it came down to the device more than anything.

Joby  19:49  
Yeah, the device and the technique, and because it seemed from early on that they were going to have to do a pretty big reconstruction, so I told. Some people, I had, you know, cancer in my hip and femur, and they're like, "Oh, I've had a hip replacement, and it was clear almost from the get-go that that wasn't, you know, wasn't like that kind of hip, they were gonna have to take, you know, they took, I don't know, 18 centimeters of my femur out, and they took the cater, which is where all the muscles attach, so um I'm trying to, sorry, Heather, I based on your question,

Heather Johnston  20:28  
that's okay, I'm trying to remember what I.. oh my goodness, interview, interviewing over 50, that's what this one's gonna be, over 55 I was saying what I wanted to talk about for a minute was how different advice was when you get a second opinion.

Joby  20:44  
Yeah, so the only real difference in advice was in the recommendation of the prosthetic used, actually multiple prosthetics, and the indication from two of the three that the technique that was being used at the place where I ended up getting the surgery was by all appearances the most promising and newest, but what I didn't do, and I thought about, was, you know, do I need to go to New York to the hospital of special surgery? Do I like, and I didn't get second opinions on cancer number two, and I can tell you why, but this one just seemed this first one seemed like, well, one, I was scared as hell, I didn't, this is my first, you know, rodeo, and and it just from what I was hearing, like, wait, this is going to be pretty damn complicated in circle repair, and so do your own work.

Heather Johnston  21:46  
What was your second cancer, and why did you not get a second opinion?

Joby  21:50  
So, second cancer was classic Hodgkin lymphoma, initially diagnosed as stage three, diagnosed as or three, ish, my oncologist said blood cancers are hard to stage, and then post PET scan stage four, and I explicitly asked, well, in addition to, like, let's light this damn candle and get this thing started asap, get the treatment started. I asked the oncologist whether this was a standard of care in terms of chemotherapy, like was if I went to lung catering, if I went to wherever MD Anderson, what would I likely hear, and he said that the chemo agents would likely be almost universally the same. Though I'm recommending an immunotherapy with the chemotherapy, and I'm making the recommendation on the basis of results that aren't yet published, but were shared at the International Lymphoma. lymphoma conference here in this big major city, you know, five months ago. So he said this will be a standard of care, except for the immunotherapy, which some people may not recommend, but the data have just come out, and I strongly recommend, you know, and I said, "Hey, I let's get this thing started right away.

Heather Johnston  23:25  
Yeah, I mean, one thing about second opinions is that you're typically doing them for a very serious diagnosis, right? Like, if you have a sore throat, you don't go get a second opinion, typically. So it's usually something really massive that's happening, and it's like the worst possible time to have to take on a mountain-sized administrative task.

Mia  23:51  
Right, right, yeah.

Heather Johnston  23:53  
Like, I remember just thinking to myself, like, I had papers all over the counter, and I was just thinking, like, Jesus, like, I don't really.. I don't have time for this. I don't know. It's not. It's really not time. It's like I didn't have the mental space right, because

Joby  24:07  
for

Heather Johnston  24:07  
sure, the idea of like dying from my cancer was just taking up every speck in my brain. It was just so hard to do it at that time.

Mia  24:15  
Yeah, can't process it yourself, let alone organize it,

Joby  24:21  
right? I, I still can't process it. I still like, I was speaking to my wife before I came up, and you know, I said, "Oh my gosh, I was just looking back through some of this stuff to just try to remind myself, like the rough timeline, and it's, you know, I can remember some, some details, but I don't, the big picture, I just can't keep it in my mind. I couldn't, certainly couldn't have done.

Heather Johnston  24:50  
Yeah, I will tell you this. I had, I ended up getting a second opinion twice. The first time was actually the result of a medical error, and that made me. A change to the other place, so it wasn't really necessarily a second opinion. It was more like, like, I have a problem here, and I need someone to step in, and I brought everything to there. But because I'm a physician, I was reading like crazy, for better and for worse, and I knew that there was a lot of variety in how much radiation people recommend for my very early one a stage cancer, so I ended up going. I got the opinion from the place where that was closer to my house, because it's a very convenient and radiation that is every single day for weeks and weeks. So I really like, convenience was an important factor for me, and they told me they recommended five days of radiation. I then went to the other place where I had had the second opinion and follow-up surgery, and they recommended six weeks of radiation. My

Mia  25:57  
goodness,

Heather Johnston  25:58  
I then thought, well, this is crazy, I'll have a deal breaker, so I talked to a third place here in this, in Chicago, and they recommended three weeks, and at the end of that, I was like, okay, right, exactly, and so this is partly the trick in this is that you know, and one of the reasons why there's so much variance in treatment sometimes for some diseases is that well, for standard stuff like I'm going to bring up again, ear infection, there are standards of care that are published, like this day and age, this is how you diagnose it, this is what the best antibiotic is this year, you know, this is what you do, but with cancer, there's just research being done all the time, and so a lot of the treatment decisions are based on how the person you're seeing, or their team, or their facility, how they interpret the research that's there. And long story short, you know, I was left thinking, God, like I'm a physician, but I like, I couldn't really understand all the data that I was trying to read on radiology, excuse me, radiation studies with breast cancer. It's like not my specialty, right? And I just have forgotten a lot about statistics and stuff. So I was sitting there thinking, Who's gonna help me decipher this? Like, now I have three opinions, like, now what do I do,

Mia  27:23  
right?

Heather Johnston  27:24  
Like, oh shit, now I've got three different answers, like, whose job

Mia  27:29  
is it to decide,

Heather Johnston  27:30  
right? Like, my primary care doctor couldn't help me, I mean, he's not a breast specialist, right? So I ended up calling each of them back, all three of them, and I said, "Hey, I've gotten three opinions, and I am very confused, and I'd really like you to explain to me why you recommended this and the other people didn't, and two of them gave me really schlocky answers. The third one was like, I'll tell you exactly why Place A is recommending that based on this study that was published in this year, and this is what the data shows, and I don't interpret it that way. Place B is recommending it, you know, and they just gave me such a clear answer, and they said six weeks is the gold standard, that is exactly what you should do. You have aggressive cancer, don't think about it. I was like, okay, great. So I did the whole shebang six weeks, but it, I wanted to bring it up because it is actually a reality of second opinions that sometimes you actually get different opinions and then you're sort of left as the patient having to be the deciding factor but like you're not qualified to make that decision so I don't know how other people do this it was just it was overwhelming to me, like in today's healthcare, there's actually like really poor trust between patients and doctors in general, for a variety of reasons that I outlined a couple episodes ago, but so it's interesting because it, you're right, it does part of the decision making process with second opinions and deciding what you're going to go with is like how do you feel about that person, and do you trust them, but you also don't know them, so like, what are you basing your trust on? There's something instinctual, I think, that goes on when you're meeting a doctor, whether it's for something terrible like stage four cancer, or whether it's just a primary care doc. I don't mean just I am a primary care doc, so I'm not belittling myself, but what I mean is there's some instinctual thing you have with somebody, right, where you're like, okay, okay, they communicate in a way I get, like they're explaining things in a way that I like, that works for me, they're explaining why they're recommending this, and that makes me feel good about them. I don't, I don't know, like, what makes you trust somebody to go with them. What do you think

Joby  29:44  
the

Heather Johnston  29:46  
crickets,

Joby  29:47  
crickets, that's a mistake, I. You know that trusting and the kind of rapport ended up being important in, well, now all three, but, but you know, two, the two primary cancers, the two big cancers, and why did I trust the opinions that one guy that for my leg it was a team of two surgeons that the supervising surgeon is the chief of the department and chief of orthopedic oncology and he said, right from the get-go, he's going to bring this second surgeon in with particular kind of expertise on this endoplasthesis that to me sounded.. oh, I'm sorry, and because he's.. I don't know, I was going to say, because he's so senior, he had a really kind of calm and clear and kind manner about him, so that that appealed to me greatly, and other, and then other people spoke highly of him, other, the other surgeon, one other surgeon I spoke to, the trust with the other guy, that the lymphoma, Hodgkin lymphoma oncologist, I was, and this is bogus, but I was actually impressed that he had said, "Look, you are welcome to go get additional opinions. I suspect you'll get very much the same medical regimen of the of the chemo drugs, the AVD. But he's like, I was impressed that he was like, "Hey, look, these results were quite recently released about this immunotherapy. It looks really, really good. And Heather, I don't have the medical knowledge you had, but I had certainly been digging in, like, like PubMed in the peer-reviewed studies, of course, and I'm like, that established some trust with me that he seemed to be that up to date on the literature

Heather Johnston  32:04  
that makes sense. How about you, Mia?

Mia  32:07  
I told the story about the, you know, the surgeon writing me back, and I think that just, you know, spoke volumes about her understanding of the psychological piece of cancer, and, and you know, how important it is for someone to feel listened to, and, and, and get a response when they're feeling like they're in a crisis, which, you know was like counterpoint to plucking a piece of paper out of my hand, but then you know then I sat and had like the full surgical consult with her, and she was so thorough, and I know you know her, Heather, she's so thorough and she's smart, and and she said to me, and I remember this, she's like, you're not gonna die from this, and like that was so what I needed to hear in that moment, and you know, obviously I'm very fortunate, knock wood, it was caught early, but she said we still have to do all these things, but this is this is not something you're going to die from. And then I heard her say the same thing to my mother-in-law. I love that. So, yeah, so all of those things, and this is not as much related to trust in people, but trust in institutions. The sort of business model of the second place being more of cohesive, integrated areas of practice, where any time I left an appointment there, I got a whole printout of every doctor that I had seen was going to see what was coming up, and that never happened at the first place. Nobody knew what anybody else was doing. Yeah, and maybe that was, maybe you know, maybe the second, maybe the place I went was like an early adopter of some technology that allowed them to do that, but Heather's making a face

Heather Johnston  34:24  
those two places are fundamentally different, like in their value system. There's something in what you're saying, and the way I interpret it is that I was writing a journal entry the other day, or something, for my Substack. I think about how lonely it is to have cancer. I'm not isolating cancer from other terrible things. This is just what I know, but I mean it's a very lonely process. No, I have found personally, and I mean to generalize for everybody, but you know, I have tons of. Loved ones around me, I've got an amazing husband, I've got amazing children, I've got great siblings, like I have a great family, but the reality is when I'm in that changing room, putting on that stupid boob gown, like I'm alone in there, and in the CT scanner I'm alone in there, and when I'm looking at my test results, my blood pressure is going up. I'm doing that alone. If there's a lot of loneliness involved, and because the truth is, nobody can understand what it's like to have scary cancer, unless you have done that, and your doctor, who's trying to help you, actually does kind of understand a little, maybe they don't necessarily get exactly what it's like to be the patient, but I mean that's their job, is that they work with people who are getting this all the time, right? So I feel like there's a special connection with doctors that treat you for really serious things, because you're terrified, and you realize that no one really gets it, but they kind of get it a little, yeah. Do you think that's part of it, Joby? Or no,

Joby  36:03  
I do. I mean, I think in the case of all three of my oncologists, like they had done this many times, so they were good people, but they were also, or.. and they, they strike me as good people who had shared that horrible moment with a bunch of people, and yeah, I think you nailed it, Heather. And also, you were, you were very chill in the way that you describe that loneliness, and I mean, I had my head in my hands over here, I'm like, it's just, it's, it is lonely, scary, like to

Heather Johnston  36:42  
this day, like most of my things are hopefully in my rear view, at least for now, but like it, it still feels lonely and scary. I went in for a mammogram a week or two, a couple weeks ago, that's not true at all. What was that MRI? I was laying in the MRI, literally thinking about that, like no fault of their own, but, like, you know, my husband's off at work doing his thing. My kids are like doing whatever they do at college, and all my friends are doing their things that they do, and like, no one knew that I was.. no one, I mean, my family knew I was there, but my.. at that moment, they're not thinking, like, oh my god, she's in the MRI scanner, like hoping that it's all okay, and you know, like, it's just you that kind of brings us back full circle to just, you know, I think personality is sometimes a reason for a second opinion. I mean, you're gonna go through something really bad, and it's important that you have the right captor

Mia  37:42  
vibe, it's a vibe,

Joby  37:44  
it's a vibe.

Heather Johnston  37:53  
I think we've given you some fodder to think about, if you're considering going for a second opinion. You heard how different the experience can be from person to person. You heard about how confusing it can be when you actually get very different opinions and are then faced with deciding between them. You heard an array of reasons that we gave in terms of why we sought one in the first place: personality differences, complex diagnosis, serious diagnosis. Ultimately, Mia and Joby and I all agreed that personality and the ability to inspire confidence were both super important. Understanding the psychological piece of cancer, as Mia said earlier, makes you feel like you have an ally and not just someone directing your treatment. Also, being up to date on current research and techniques is confidence inspiring, as Joby found out. The ability to explain why people have different opinions is important, as I found out. Convenience and ease of process is something that Mia touched on when she described two very different institutional approaches to coordinating the various specialists, and often it's about all of these together, kind of like a doctor pie, and you just have to choose your flavor. Thanks for listening today. To catch up on more episodes, and to get new ones delivered directly to you, subscribe wherever you find your podcasts: Apple, Google, Spotify, iHeartRadio, and more. If you'd like to be a guest or have an idea for an episode, let me know@www.dr patient podcast.com That's Dr Patient podcast.com Here's the disclaimer. Even though I am a doctor, I'm not your doctor. These stories, my comments, and all discussion is purely reflection about what's working in the healthcare system and what isn't. Don't use any medical information that you hear in these episodes to diagnose or treat yourself. If you have a question about. Your health, get in touch with your doctor or local health clinic.

Transcribed by https://otter.ai