Empowering the Patient: A Doctor Extols the Importance of Second Opinions

VOLUME 10, NUMBER 4

JORDAN J. COHEN, M.D., PRESIDENT

JANUARY 2001

Empowering the Patient: A Doctor Extols the Importance of Second Opinions

By Barbara A. Gabriel

Jerome Groopman, M.D., is the
author of "Second Opinions."

A clinical researcher who has been on the front lines of developing experimental therapies for our country's most life-threatening illnesses, Jerome Groopman, M.D., has earned a name for himself as a respected academic physician. But in "Second Opinions," Dr. Groopman focuses on the personal plight of patients who are caught up in the whirlwind of serious diagnoses and must make vital decisions regarding their care, often under the duress of limited time frames.

In each of the book's eight chapters, Dr. Groopman tells the story of a patient suffering from a potentially fatal disease, including acute leukemia, breast cancer, and bone marrow failure. By recounting the experiences of these patients, which include himself, his grandfather, and his son, Dr. Groopman emphasizes the rights of patients to seek second opinions and demand the highest quality of care.

Dr. Groopman, the Recanati professor of medicine at Harvard Medical School and chief of experimental medicine at Beth Israel Deaconess Medical Center, is also the author of the best-selling "Measure of Our Days."

Q: What personal experiences generated the idea for this book?

A: First was the very personal experience of nearly losing my son because of a series of medical misjudgments and my initial reluctance to press for a second opinion. There were also instances in which, as a physician, I had not sought second opinions for my patients. I describe one such instance in the book about a man who had skin nodules that I assumed to be leukemic but turned out to be a fungus. My failure to consider seeking a second opinion in that case turned out to be a major mistake. I also want to encourage physicians, patients, and their families to understand the vital importance of obtaining second opinions, since no one is infallible.

Q: What do you perceive as the unifying theme of the patient stories you recount?

A: The first one is that careful listening is necessary for critical thinking. Another is that we all have limits we need to recognize and, as physicians, we must put our egos aside and encourage our patients to get second opinions even if they reveal us to have clay feet. The third deals with medicine as it's practiced now. We're all under tremendous pressure from the managed care system, a situation that makes listening difficult and can inhibit procuring second opinions to the detriment of patients.

Q: Why did you choose to begin your book with a story about yourself as a patient?

A: My own story showed that despite all my training and background, as a patient, I made major mistakes and would have greatly benefited from the guidance of a physician who would have steered me to an optimal second opinion. I wanted to illustrate with that story how, despite all the rational knowledge you may have as a doctor, when you're in the role of the patient, it can be very hard to make the best choices, and you can be easily misled by looking for a quick fix.

Q: What do you do when your second opinion differs from another physician's?

A: It's very important for physicians to communicate from the point of view of mutual respect and not get involved in ego battles that can compromise the best interest of the patient. When two experts disagree, both should attempt to view the case from the other physician's viewpoint. Sometimes it boils down to a philosophical difference. How much risk do you, as a physician, believe is worth taking, and how much risk does the patient want to take?

Occasionally, there are problems with second opinions because of agendas that are not attractive - ones that involve money or fame. And then sometimes there are second opinions that involve what I call the "Pygmalion complex." This occurs when research physicians fall in love with the experimental drug they are working on, potentially coloring their assessment of a patient's case and the way in which therapeutic options are presented. In such cases, it is vital that patients seek second opinions from institutions that are not directly working on the drug.

Q: You repeatedly refer to the importance of "intuition" in diagnosis and treatment. What do you mean by this term, and why do you think it is so important?

A: Intuition is the intersection between information and experience, that area where we have a sense or a hunch about what's best. Each patient is an individual, and what's best for that person is a complex confluence of not only his or her objective clinical situation but also his or her beliefs, needs, background, and goals. I emphasize intuition because I think it is at the core of the art of medicine - something distinct from algorithms and decision trees. It's a call for a kind of medicine in which patients and physicians act as partners.