Why and how to get a second opinion [PODCAST]

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“In the end, the patient-physician relationship is crucial to overall decision-making for any plan of care, treatment, or surgery. There are many variations in the reviewed studies in health care literature as to the cost-effectiveness of second opinions in medicine. These studies could be easily misconstrued that there are no benefits to second opinions, thus possibly leading to little pay or no pay by insurance companies. A patient should consider the substantial short and long-term implications of their body’s health and well-being. In other words … it is worth it. Go with your intuition. When in doubt, or if you have more questions, get a second opinion.”

Sonya M. Sloan is an orthopedic surgeon and author of The Rules of Medicine: A Medical Professional’s Guide for Success.

She shares her story and discusses her KevinMD article, “Think again: Get a second opinion.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Sonya Sloan. She is an orthopedic surgeon, and she wrote the KevinMD article “Think again: Get a second opinion.” Sonya, welcome to the show.

Sonya M. Sloan: Thank you for having me.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Sonya M. Sloan: Yeah. I am based out of Houston. I have lived in Texas all my life. Orthopedic surgery, first Black female at Baylor College of Medicine. I do locums, traveling all over, with multiple state licenses. Currently, for the past five years, I’ve been a contractor for Indian Health Service, Navajo Nation.

I have a passion to do other things, so I have other serial entrepreneurship. We met before. I am doing Rodox telemedicine as well, and I have written a book, The Rules of Medicine, and I do a lot of blogging as well. I have several nonprofits: Sloan STEM Plus Arts, increasing minorities’ exposure to the sciences. And then I have kids that have busier schedules than mine, so I’m trying to be present always.

Kevin Pho: Why is it important for physicians to have interests outside of their primary job in medicine?

Sonya M. Sloan: Balance, man. We have to have balance. Currently, in today’s society, we definitely have to have it. I think when you and I probably trained, there was no 80-hour work week, and so there was no emphasis on lifestyle and quality of life. And so now things have changed, and people have figured out that we can do things virtually in so many other ways, telemedicine and some other stuff. But the balance, for our psychological stimulation and health, is so, so important.

Kevin Pho: So you mentioned that you also do some locums and you work for Navajo Nation. As an orthopedic surgeon, tell me, what’s that like?

Sonya M. Sloan: It’s really interesting. You get to meet a lot of different people, a lot of different situations. You have to be sort of secure in who you are and what your skills are, your skill set, because you never know what kind of challenges you’re going to meet. At the Navajo Nation hospital in Gallup, on the Four Corners, I see everything: massive trauma, which Baylor College of Medicine trained me for at Ben Taub, our county hospital. But it functions as a level three hospital, yet acts as a level one.

So again, you have to know what you’re comfortable with going into it. It gives you life experiences: to travel, to meet other people, to see other cultures, to have some things that are outside the norm, the humdrum of an everyday practice. So it’s been good for me. It may not be cut out for everyone, but it’s definitely an experience that I have loved.

Kevin Pho: And for those interested in pursuing some of those interests like you described, working for Navajo Nation, locums, what kind of resources do you recommend?

Sonya M. Sloan: You definitely have to find the right company to work with. I’m with CompHealth; they’re out of Utah, and there are multiple companies out there. Just making sure that you’re getting what you really want. You can always negotiate. This is your time, your energy, your effort. So go for the times that you want to go: one month, two months, maybe 10 days, whatever. You pick and choose where you go, and you tell them what you’re willing to do: “I don’t want to do spine. I don’t want to do massive trauma, pelvises,” that kind of thing. So those are the things that we’re comfortable with, and you go in with that negotiation. So it’s definitely your call.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Think again: Get a second opinion.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Sonya M. Sloan: Yeah. So as you know, there are definitely some biases, medical biases, and things that people don’t, unconscious bias. And so what I see a lot of times is, when patients come in, you have three generations, right? We have the generation which I call the baby boomers: “Tell me what to do, Doc, and I’ll do it.” You have the second generation, that is the Google MD, WebMD, and they think they already have their own doctorate, kind of thing: “I’m going to do it this way. I just want you to sign off on it and write the orders.” But you need the combination of both to have a great physician relationship. It’s like, let you be educated as a patient, but also take knowledge of what I have to offer, and let’s come to a happy medium.

And so many times patients, and definitely this older population, walk in, they take it for what it is at face value, and they do it, and they never question. And so there’s a difference, and there’s a shift where people are now questioning what we’re doing.

There are many studies out there, and basically the article talks about them, that say one in 20 will have some type of medical error, or the fact that they didn’t get a second opinion, something happens to them. So it’s been called the third leading cause of death in America, which is amazing. That was a study that was done several years ago by Mayo, and it surprised a lot of people to look at the medical error that happens, and why.

And again, in 1972, people were looking at it to benefit the insurance companies: “Let’s look at this. How can we stop people having procedures, surgeries, and having to have certain things done? We’ll get a second opinion.” Insurances thought that they were going to sort of get off. But what it showed was not only did people need the second opinion, but that over 20 to 30 percent changed the diagnosis, and that most people, two-thirds, didn’t even agree with the initial and the second opinion. So definitely get a second opinion, because we know it’s the practice of medicine, right? It’s an art form. There are standards of protocol, but there are also different ways that all of us are going to do different things.

Kevin Pho: So from a patient perspective, are there any types of cases that are more amenable to second opinions? And if so, what’s the process of doing it? Is it as simple as just finding another doctor and starting from scratch again? So walk through the process.

Sonya M. Sloan: Yeah. So you want to think: If you walk into an office and they tell you cancer, if you walk into an office and sometimes you have to have major surgery, you want to think second opinion first. Don’t accept it at face value. Don’t expedite because they’re pushing you, they’re rushing you. You have a little bit of time. I say that with a grain of salt, but let’s say cancer, for instance. I’ve gotten a diagnosis of cancer. I probably may have known it or not known it, whatever else. You could ask that doctor, “I’d like to maybe be referred to someone else, just to get a second opinion.” That doctor should not be offended that you want to get a second opinion. They should encourage it, in fact, because it will either line up with what they’ve already found out in their game plan, or their plan of action for the patient, but also really benefit you as the patient.

And secondly, you want to make sure, if it’s something like surgery: “I want to know who the surgeon is, what they can do, how comfortable they are with these types of procedures, maybe how many of these procedures they do.” I’m not a hand expert. Can I do simple things? Yes. Can I do fractures, carpal tunnel? Yes. But major, major reconstruction, that’s not my faux pas, so therefore I send it out. I get someone else to do a second opinion.

So if your doctor is comfortable in doing that, you want to go that direction. If the doctor is very offended and taken aback, then your red flag should go up: “Why are they so insistent? I’m asking for a second opinion.” This is your body and your health, and so you have to stand up and advocate for yourself. Most insurance companies will allocate for you to have a second opinion. They may fight you on it now, but most of them will allow that second opinion. And if not, it is definitely worth the money that you would have to pay, $150 to $175 cash out of your pocket. If you need to get a second opinion, it’s worth it.

Kevin Pho: Now, as you mentioned, medicine is an art, with a lot of gray areas when it comes to diagnostics and treatment plans. What happens if you have two medical teams with different conclusions?

Sonya M. Sloan: I think it comes down to that relationship, that patient-physician relationship. When you jive with someone, if that energy between you and that doctor is good, you have, and I call it rule 12, an intuition that you just know: “This is the person that I should go with. This is the person I’m more comfortable with.” Either that doctor has taken time out to sit down and really talk to you, describe things, explain things, write out a game plan for you, or they may be willing to talk to you, let you settle with that new diagnosis or this plan of action, and say, “Let’s come back and discuss it later on.” So those are the things that you want to look for.

If it comes down to A or B, who am I going to go with, when they’re saying it’s almost the same thing? Go with who your gut, your intuition, is telling you to go with, but more importantly, what you’re comfortable with and what you can buy into, because this is going to be a joint effort between you and that physician.

Kevin Pho: I’m seeing a lot of major academic centers commercialize second opinions. You pay hundreds of dollars, and you get a second opinion. So what are your thoughts on those types of sites?

Sonya M. Sloan: I definitely understand the money side of medicine. Recently I was on TikTok and said, “What is the big thing that you really don’t agree with anymore?” And it’s the financial side of medicine. It is a business, and we both know that. And so understanding where patients may not see it: “Oh, my doctor’s going to care for me.” The bottom dollar: What most of these companies are going to do is look at where they can cut, scrimp, save, whatever, the shortest amount of time, the least amount of resources, that kind of thing. So when it comes to that, I still say go for what your gut says. Put the money into it. It’ll be worth your time, your energy, your health.

Kevin Pho: And in terms of physician shortages, sometimes it’s not as easy to find a second opinion, especially if you’re in a rural area or an area where there’s a lack of specialists. So what kind of options do patients have in those scenarios?

Sonya M. Sloan: Yeah, and that’s classic for where I’m at right now. At the Navajo Nation, a lot of the cases that we send out have to be referred out. So you have to get, one, a PRC, a physician referral confirmation. And so once that’s finally approved, maybe five days, then you can go and see this other doctor. That doctor may then decide to get their own X-rays and decide their own surgical plan. And what if you don’t even jive with that doctor? They have to start the process all over again, which, for a fracture or cancer or something else, really sets you back in time.

I do tell those patients, “You can go someplace else. You can then later submit to the insurance.” It may be out of their insurance coverage or whatever else, and that may even be out of state. But most people, specifically if it comes to their children, will do that, because it’s worth that for their lifestyle, for their quality of life, for their peace of mind.

Kevin Pho: We’re talking to Sonya Sloan. She’s an orthopedic surgeon. She wrote the KevinMD article “Think again: Get a second opinion.” Sonya, what are some take-home messages that you want to leave with the KevinMD audience?

Sonya M. Sloan: So one is, speak up for yourself. Be your own advocate. As patients, we walk into doctors’ offices and we’re intimidated. This is your body. This is your life. This is your health. So therefore, speak up for yourself.

Take someone with you. Right now, of course, with COVID, you can always take a family member or somebody else in. It’s almost like you get your own second opinion from whoever’s with you, the spouse, the friend, the mother, whoever it is, who says, “Yeah, I listened to what the doc said. It was actually good. I think what they said was great.” Or you’ll get the others to say, “They weren’t. That was crap. You don’t have to talk to this person again,” or whatever else. And I hate to say it, but it does happen. It really does happen. So speak up for yourself, advocate for yourself.

And then secondly, educate yourself. We talked about Google MD and WebMD. There’s so much information out there. It is perfectly fine for you to come in with what information you have sought out, what you have, what questions you may have. And then I tell patients, definitely come with your question list. No doctor should be intimidated by answering all your questions. And if time is an issue, when you call and you make that appointment, say, “This is a second consultation,” or “This is going to take a little bit more time, because I do want to speak to the doctor.” Let whoever’s booking that time know it’s not a 10- or 15-minute window; this is going to be a 30-minute window, kind of thing. So those are the things I would tell patients to do.

And then again, never feel intimidated to want a second opinion for yourself. Again, go with your intuition. If it’s not right, if it’s not comfortable, if you have other people in your ear who are saying something is not right here, go with that. Listen to that. I was watching Chicago Med the other day, I think it was Tuesday night or whatever, and there basically were two cases that were wrong, misdiagnosed over years. And so some patients get comfortable with that diagnosis, because it becomes an identity for them. And so you also want to challenge yourself by saying, “I’m the patient. Is this right or wrong? What benefit could I have in exploring a second opinion that could help me long term?”

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

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