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Because foot surgery, especially if it is a revisional/repeat foot surgery, is a major decision, the topic of getting a second opinion frequently comes up during pre-surgery discussion. But what does it mean to get a second opinion? In the world of surgery, it means getting another educated perspective to help you decide if you should take or decline the treatment advice of the original health care provider. Now that you now what second medical opinion is, let’s learn how, when and why to get one.
How, why and when do you get a second foot and ankle surgery opinion?
This conversation is frequently initiated by a patient or a family member of a patient but could also be brought up the potential surgeon.
Surgeons may offer to refer for a second opinion, if they sense that the patient is not committing to proposed surgical plan despite, what seem to be, clear benefits of proceeding with surgery. This is especially true when benefits of surgery significantly out weight the risk of surgical complications.
Patients, on the other hand, request a second opinion when they need a peace of mind to help them decide if specific proposed surgery is the best in their situation.
These situations may include times when:
1. there are multiple diagnosis or diagnosis is not clear
2. your condition is rare, and your treating doctor does not specialize in treatment of this rare
illness/condition
3. your doctor does not specialize in the surgical subspecialty you require
4. you are told surgery is your only treatment option
5. you are interested in cosmetic or purely elective surgery
6. your doctor’s treatment plan has not helped you improve
7. there are multiple treatment options, and it is unclear which one would work best
8. the treatment proposed sounds risky or is not widely used in the medical world
But how do you know if the medical specialist providing you with this second opinion is offering you something better than the original doctor?
You must make sure that that doctor does a comprehensive
interview with you, reviews your medical and surgical history, your Imaging (x ray, ultrasound, MRI, CT scan, nuclear bone scan etc.) data, laboratory findings, your expectations and risk factors, social situation and support systems, work circumstances and possible required accommodations.
It is your responsibility as a responsible patient to ensure that the doctor providing second opinion receives all your current medical records to be able to provide this comprehensive assessment and come up with the recommended plan.
I have previously discussed the importance of clear and open communication with your doctor. In these blog posts, I provide comprehensive review of essential conversation topics with your surgeon, mental preparation, and ensuring that you have appropriate home prep equipment.
Once the second opinion providers are fully aware of your medical, surgical, and social circumstances, then they may propose an alternative treatment method or may confirm that the original doctor’s proposition is the best treatment approach for you.
When meeting with second doctor, I recommend that you come prepared to take notes and ask questions. Much of the advice offered may be technical in nature. It is much easier to write facts down to discuss in detail or further research later.
Do not hesitate to ask the doctor if their recommendations are based on their previous experience, academic research or both. Current world of medicine and surgery is becoming more and more evidence based, so it is completely appropriate to request a medical/surgical scientific paper that backs up doctor’s recommendations. On the other hand, it is important to realize that not all medical and surgical knowledge can be supported by high level of research evidence. Just like any other field, surgery is an ever-evolving field and surgeon’s experience and knowledge frequently substitute controlled scientific experiments. If you can find an experienced surgeon who also backs up her/his knowledge with scientific date, you can have an additional degree of confidence in the proposed surgical plan.
How to find a medical specialist to get a second opinion?
Though it may seem uncomfortable, the easiest way to get referred for a second opinion is to ask your current treating doctor. A good doctor should not find such a request offensive but, instead, should welcome it. In fact, I frequently refer patients with complex surgical situations to my colleagues who sub specialize in conditions these patients have. Just like in any profession, a doctor becomes a more skillful diagnostician and treatment provider when spending increased number of hours learning and treating specific medical conditions. If the treatment course selected for you is optimal, then the second doctor should be recommending the same or very similar treatment approach. If my patient elects to continue
with the second doctor, I only welcome it. To me, patient’s positive experience and outcome are more important. If your doctor is refusing to refer you, it is time to change the doctor.
Some patients are afraid that requesting a second opinion and finding another doctor will lead to potential delay in treatment; however, it is more important to get the correct diagnosis and treatment plan specific to your condition. Unless the diagnosis is cancer or condition that is changing rapidly, it is always safer to request a second opinion for elective and non-urgent surgery.
Your doctor may refer you to another doctor in the same office or in another medical/surgical practice.
Alternatively, you, as a patient, may want to do your own research to find a specialist you would like to be referred to.
With the advance of internet, it is easier than ever to locate a second opinion specialist. Sometimes, your second opinion specialist may not be within your driving distance. For cases like these, you may request an evaluation through a combination of written and phone communication. Video appointments for second opinion are also becoming widely available.
Major medical academic institutions provide remote second opinion:
University of California at San Francisco
https://www.ucsfhealth.org/second-opinion
https://www.ucsfhealth.org/clinics/foot-and-ankle-service
Stanford University:
https://stanfordhealthcare.org/medical-clinics/surgery-clinic/patient-resources/second-opinion.html
Cleveland Clinic:
https://my.clevelandclinic.org/online-services/virtual-second-opinions
Massachusetts General:
https://poso.partners.org/?CoBrandedDeptId=5
An increasing number of podiatry practices are offering remote and in person second opinion services for treatment of foot and ankle conditions (both surgical and non-surgical). A simple google search revealed below listed podiatry practices with such service:
University Foot and Ankle Institute
https://www.footankleinstitute.com/podiatric-virtual-consultation-foot-ankle-second-opinion
Foot and Ankle Center of Washington
It is essential that the doctor you are being referred to is a subspecialist and has many years of experience in the body area/ system you are considering surgery.
The easiest way to find an alternative provider within your network of covered doctors is by calling your insurance company or searching online insurance provider directory. Once you know who your provider of interest is, I recommend doing some background research and look up reviews online through website like www.yelp.com or www.healthgrades.com
Of course, these website tend to have skewed reviews as people tend to leave feedback more when they receive above average or significantly below average service but they should be providing you with a starting point.
Next step you can take is to contact an appropriate specialty specific medical board for your state to see if the doctor you are interested in is good standing and has any issues with their record.
For example, if you wanted to research a podiatry doctor in the State of California, you would go to Medical Board of California Website where you can do license search to find out more about specific doctor’s status/information.
According to State of California Medical Board’s website https://search.dca.ca.gov/,
these are the steps to follow:
1. Click on “License Search” on the home page.
2. Choose license type: Click the checkbox for “Physician and Surgeon” and then
“Search by Name.” Make sure correct certifying board is selected. For
podiatrists, it would be Podiatric medical board
3. Enter the doctor’s last and first name and then hit “Search.”
4. Click on their name. Review license details, including verifying whether any
disciplinary actions are listed at the bottom of the page.
In addition, you may look up providers of specific specialty through their corresponding society/association websites. For the field of podiatry, APMA member directory is one such resource: https://www.apma.org/Directory/FindAPodiatrist.cfm
To find a podiatrist who specializes in surgical treatment, ACFAS website is a good resource to look up a specialist ACFAS – Member Directory
American Society of Podiatric Sports Medicine has a nationwide list of doctors who specialize in treatment of sports related injuries. They provide a nice state specific map on their website that can assist you in selecting the right doctor for your sports injury. American Academy of Podiatric Sports Medicine Member Directory (aapsm.org)
It is important to understand, that your second opinion doctor may not disagree with the original doctor’s plan or may offer a more fine-tuned approach to treatment. You may choose to get a third opinion if you strongly believe that the second opinion was not comprehensive or reliable. This should be extremely rare if you are thorough in your second opinion doctor research.
If you use above advice to decide on best treatment plan for your surgical or medical condition, you should feel less anxiety and experience a sense of confidence as you proceed with surgical or conservative treatment modality.
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Author bio:
My name is Dr. Marat Kazak. I have been working as a professional Podiatrist serving Northern California community since 2014. My extensive medical and surgical knowledge combined with an ongoing curiosity to learn about the latest trends define my success in the field of foot, ankle and leg medical and surgical care.
The goal of this website is to give you the tools to better care for yourself, to dispel medical myths, and to empower you with information to save time and money! If you are looking for an answer on foot and ankle pain, this is the place to find it. If you do not see your topic of interest covered, please send me a message and I will do my best to discuss it thoroughly in my next upcoming post.
Visit this blog often to learn about latest developments, treatments, and approaches to healing and recovery!