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Don’t be afraid to get a second medical opinion — it can be helpful

SINGAPORE — If Ms Agnes Fong had followed the advice of the first doctor she visited after recovering from a medical condition in September last year, she could now be living with only half of her colon.

More than half (56 per cent) of patients mentioned a difference between the diagnosis or treatment between their first and second opinion, according to a study published in the Israel Journal of Health Policy Research in 2017.

More than half (56 per cent) of patients mentioned a difference between the diagnosis or treatment between their first and second opinion, according to a study published in the Israel Journal of Health Policy Research in 2017.

SINGAPORE — If Ms Agnes Fong had followed the advice of the first doctor she visited after recovering from a medical condition in September last year, she could now be living with only half of her colon.

Her doctor had advised the 60-year-old businesswoman to undergo elective surgery for her condition, diverticulitis, which occurs when abnormal pouches that develop in the lining of the colon known as diverticula become inflamed or infected. It had also left some scarring in her colon, which is the large intestine.

“The potential surgery complication rates the doctor mentioned seemed high. I also felt very anxious when he told me that up to half of my colon may be removed during the surgery — that’s a lot of colon to be cut off,” said Ms Fong.

Colectomy, a surgical procedure to remove all or part of the colon, carries a risk of serious complications. Some complications include bleeding, blood clots in the legs and lungs, infection and injury to organs near the colon.

She sought a second medical opinion from a senior consultant at another hospital and he offered another perspective and more information on her condition.

While surgery is an option, it is still safe to take a conservative approach for now, said Ms Fong, who has resumed her daily activities and is taking probiotics to maintain her gut health.

“Although I felt uneasy, I initially planned to go ahead with the surgery as advised by the first doctor. However, my daughter nagged at me to get another medical opinion. I’m glad I did because I have a clearer picture of my condition now and feel less anxious,” she added.

Increasingly, seeking a second opinion has become a routine part of medical treatment and the reason why patients like Ms Fong now form a substantial proportion of new cases local doctors see.

When receiving a severe medical diagnosis, 87 per cent of Singaporeans would look for a second opinion, according to survey findings released last year by medical management solutions firm Medix.

At orthopaedic surgeon Dr Kevin Lee’s clinic, second opinion seekers make up about a fifth of new patients.

Assistant Professor Toh Chee Keong, a senior consultant medical oncologist at the National Cancer Centre Singapore, estimated that one in 20 new resident subsidised cases and one in 10 resident private cases he sees are those seeking a second opinion.

Studies show that this practice is generally higher in orthopaedics, general surgery and among cancer patients.

Dr Christina Low, co-founder and chief executive officer of HiDoc, a Singapore-based telehealth platform, said patients today are generally more cautious about their treatment plans.

Common reasons that patients give for seeking a second opinion include doubts or dissatisfaction with the original diagnosis or treatment, said Dr Lee of Pinnacle Orthopaedic Group. They may also want to get reassurance that the original proposed treatment plan is the correct or sound one, he added.

TELEHEALTH PLATFORMS

A growing number of online services has also provided new ways for local patients to get a second medical opinion quickly.

Since HiDoc’s launch two months ago, three to five per cent of its cases are second opinion consultations and the number is expected to rise, said Dr Low.

“For example, a patient injures his or her knee, tearing the anterior cruciate ligament and the current doctor suggests surgery. With telehealth platforms like HiDoc, the patient can get another opinion within 24 hours from a Singapore registered specialist before deciding on the proposed treatment plan,” she added.

Patients seeking a second opinion from HiDoc’s current network of 20 Singapore registered specialists may either reach out to a specialist directly or engage its care team before making a virtual consult appointment through its platform. The consultation fee is priced at S$120.

Once they have confirmed their specialist, patients can upload test results including imaging reports onto the platform. They will get a second medical opinion via real time video feed within 24 hours.

Dr Low believes that opportunities for second opinion teleconsultation will grow due to its convenience, reduced waiting time and cost savings. However, she stressed that they do not replace conventional clinic consultations.

“If at any point, the specialist feels that a clinic visit is more appropriate for a further assessment, the patient will be advised to do so,” she said.

HELPFUL TO HAVE ANOTHER PAIR OF EYES

A second opinion can be helpful when navigating tough medical decisions, said doctors whom TODAY spoke to.

The practice is not uncommon even among doctors and some may even get their patients to seek another medical opinion if the case is a complex one.

“In some complicated cases, I will get my patients to seek a second opinion from another specialist. If both myself and the other specialist have the same diagnosis and treatment plan, then it’s highly unlikely that we are both wrong,” said Dr Lee.

More than half (56 per cent) of patients mentioned a difference between the diagnosis or treatment between their first and second opinion, according to a study published in the Israel Journal of Health Policy Research in 2017.

The study also found that 91 per cent of patients preferred the second opinion, reported feeling satisfied (84 per cent) and felt improvements in health (77 per cent) after getting a second opinion.

While the diagnosis by different doctors may not differ, treatment plans may vary.

For instance, one doctor might offer a more conservative approach while another might suggest surgery, said Dr Lee, whose personal approach is to try conservative treatments before surgery.

“Most of the time, a second opinion is useful because patients need confirmation that (their treatment plan) is the best decision. Patients will tend to listen to the specialist that they choose to go to,” said Asst Prof Toh.

According to Dr Lee, the most important thing that predicts a successful treatment outcome is the rapport and trust between doctor and patient.

“If the patient feels doubtful about the diagnosis, treatment plan or the doctor, then it is the patient’s prerogative to seek a second opinion especially if surgery or other invasive forms of treatment have been offered,” he said. 

WHAT TO CONSIDER BEFORE SEEKING A SECOND OPINION

When seeking another medical opinion, Asst Prof Toh advises stopping at two as going for a third or fourth opinion may confuse patients.

However, a third opinion may be required if the first two opinions differ wildly, said Dr Lee.

Patients who are unsure can get their family doctor’s advice on who to go to, or ask family and friends for recommendations, he added.

“The medical community is a small one and your family doctor will be able to tell you about the clinical reputation of the doctors you are seeing. Advice from a trusted family doctor and your own friends should take precedence over what you read on the doctor’s website or social media page,” said Dr Lee.

Patients are advised to be well prepared before going for their second opinion consultation. This involves having a copy of medical records including investigations and test results, as well as diagnosis and treatment plans made by the primary doctor, said Dr Low.

“It will also be good to write down your concerns, from treatment options to costs,” she said.

Ms Fong’s experience of reaching out for a second opinion — her first for a medical condition — has been an eye-opener. She has decided to follow up with the second doctor, whom she feels more comfortable with, although the clinic is located further from her home.

“I’m quite surprised that different doctors have rather different medical opinions when it comes to managing the same disease,” said Ms Fong.

“For me, the most important thing was that the second doctor was able to put my mind at ease with his communication style and by sharing more information about my condition. Even if I eventually choose to undergo surgery now, I won’t feel so anxious about it.”

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