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How to Look For a Second Opinion

Trying to find a second opinion for your medical or surgical diagnosis can be not only a frustrating and lengthy process, but also a terrifying experience. How do you find the "right doctor"? Can you really trust your referring doctor to send you to someone with perhaps more knowledge, skill, or experience without bias and outside of his practice group or referral network? Who should you ask about the doctor? How should you research that doctor? These are all the questions you should be asking when looking for a second opinion, but not all of them are as easy to answer or accomplish as you might think. While there is no general guideline to follow and the search for the "right surgeon" can be quite an arduous process, here I will try to help you to make as educated of a choice as you can.

First of all, lets quickly answer how you should NOT be looking for a second opinion. And as frightening or unorthodox as this may sound to you, you should not be choosing your doctor based on his/her age. Just because someone looks of age and practiced for the last 30 years does not necessarily make them the best choice to be your surgeon. I am not saying experience does not count, of course it does. What I am saying is that the medical field, especially in spine surgery, has been progressing so rapidly that older doctors may not necessarily be up to date on their knowledge, let alone the surgical skills needed. Of course many doctors who advanced the medical field are, in fact, older and yes they are the ones everyone would like to be operated by, but most are probably not local for you. If you choose to travel, you should certainly research current leaders in their fields for your particular needs and make an appointment. Be careful, however, using age as your criteria when researching local surgeons. While some probably are extremely capable, many aren't and frankly are not interested in keeping up with the current knowledge and advanced skills. They are simply comfortable with what worked for them for the last 30 years. Be mindful, however, that what worked in surgery 10 years ago, might not work anymore today. In fact, when it comes to back problems and spine surgery, most of what we did in the early-to-mid 2000s simply does not work today. The reason for so many back fusion revisions today is because of our lack of knowledge about them as recently as only 10 years ago.

So how SHOULD you look for a second opinion? First, ask friends, family, neighbors, etc. If you hear the same name repeat itself over and over, that is a first clue that is probably a good doctor. Also, if you have friends in the medical field, be sure to ask them. They will likely tell you their unbiased opinion about everyone they know. Your referring physician may only have 2 or 3 "regular docs" they refer to and may not necessarily send you to the one you should really be seeing. Also, if you ask your surgeon for a second opinion, he/she may not be willing to send you to someone they hold grudges against or may see him/her as their "competition." But DO NOT settle on one name after hearing about it once. Ask around. If you heard it three or more times from different people, that is a good sign.

Second, once you settle on a name research it yourself. And I do not mean to just "Google it" and look at the reviews. People who leave reviews tend to be the ones who were dissatisfied for one reason or another. No one can please everyone and some patients may not like their doctor. And that is ok too. Most people who are satisfied, however, rarely leave reviews. In fact, some of the biggest names in neurosurgery have fairly bad reviews about them. What I DO mean is read about whom the surgeon was trained by, are they published in their field? Are they on a design team for a new product? Do they teach or present at national meetings? Do they play any administrative function in the organization they belong to? Your second opinion does not need to be an academic neurosurgeon, but even a neurosurgeon in private practice should be involved in certain aspects of their organization whom they are members of, or be published in their field (especially with recent publications), or be part of a design team on a product that is now widely used and is making a difference in the medical field. Any involvement at all, really, is a good sign that the surgeon is actively keeping up to date with their knowledge and skills. It is not enough, these days, for surgeons to only operate. Medicine changes and so do the surgical techniques, indications, and knowledge.

Third, and I mentioned this before already, pay attention to "whom" trained them but not necessarily where they were trained. Just because someone graduated from Stanford or Hopkins, does not mean they are automatically world leaders in neurosurgery. In fact, big name Universities may not necessarily have the biggest name surgeons in ALL of their subspecialties (Yale, a big name institution, does not have a strong neuro-spine department, for example). Remember, surgeons change their practices occasionally and may relocate. What makes a University a big name powerhouse, is precisely those surgeons. Follow the surgeon, not the name of the institution. If your second opinion was not trained by anyone in a leadership role for that particular area, did they take enough hands-on CME cadaver lab courses to practice their technique? How many did they take? Who taught them? One CME lab is not enough to perfect a surgeon's technical skill. In general, surgeons should take several courses and then schedule a visit to a hospital where one of the leaders is currently operating to watch them perform at least a few "live" surgeries. If the surgeon can assist for a day, that is even more preferable. Be wary of surgeons who say they were "trained" in a particular area by taking "a course."

Fourth, stay away from places that carry "Institute" in their name. This is not a solid rule by any means, however. For example, Barrow Neurological Institute (BNI) in Phoenix, AZ is one of the best places to go to for any neurosurgical needs. I am referring to places such as the Laser Spine Institute, or equivalent. Such places tend to do the "minimally invasive," or "laser," or "no incision, no scar" procedures that have absolutely no objective evidence behind them and are not FDA approved (so you have to pay cash for). If you truly want to go to an "Institute" best way to research it is to research the actual scientific literature behind the procedures they promise you in their advertising. It turns out, laser spine surgery does not have any.

Last, but certainly not least by any means, once you've made your educated decision and due diligence and decided on a name, just give that doctor a try. Go see how you feel about that doctor. Sometimes, you may simply not get along with them. Some doctors are serious with patients, some are funny and just have "a way" to make a patient feel comfortable. Some patients tend to like the "serious" doctor better than the "funny" one and vice versa. Some patients are comfortable only when they realize their surgeon knows what they're talking about. But DO NOT use this method as your first one when making a decision. A doctor SHOULD sound knowledgable about what they do AND make you feel comfortable, BUT this alone should not sway your decision. Ask challenging questions. Demand details. Surgeons who tend to make you feel "good" or "comfortable" with small talk to avoid actual questions are certainly the ones you should be avoiding. In my opinion (and it's just my personal belief), a surgeon should be professional and serious with you. After all, you're talking about operating on another person! I also think that a surgeon should explain EVERYTHING about the surgery, the pros and cons, exactly what to expect immediately after the surgery and while you're in the hospital, how much pain there will be, how it will be controlled, etc. Some patients may find this is too much and get scared away, but I still feel they should know what they're about to go through. The more you know as a patient the better you can try to prepare yourself mentally. It makes a big difference in your recovery!

There is no right away of researching any physician and finding the best one for you. It is still a highly unscientific process that comes with a lot of trial and error. However, if you follow at least some of the points I made earlier, I feel like you will be more likely than not finding the right fit.

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