Umpteen opinions?
There are certainly times when a second opinion may be advisable. Those capable of seeking such an opinion include anyone on the medical team, as well as the patient. Since patients nowadays are more active in their medical care, they are less hesitant in approaching this subject. Still, it is not possible for every biopsy in the country to be interpreted at least twice, because there are not enough pathologists to accomplish that. It is common for pathologists in the same department to spontaneously consult among each other, so that many cases will already have had the benefit of at least one additional pair of eyes. When a cancer is unexpectedly found, it is customary for pathologists to confirm the diagnosis by sharing the slides with at least one colleague.
Under one or more of the following circumstances, an opinion may be sought from a reputable consultant: (1) no satisfying diagnosis can be reached within the department; (2) a marked discrepancy exists between the departmental diagnosis and that previously offered on the same slides by a referring pathology department; (3) a discrepancy exists between the expected diagnosis and the final interpretation; (4) the diagnosis is rare; (5) the diagnosis, although apparently settled, leaves room for a difference of opinion in a patient who may, for example, lose her ability to have children, or who may face a major surgical operation; (6) the patient or the patient’s physician requests a consultation. It is difficult for non-medical people to judge this situation, so that they must usually rely upon the advice of their treating physicians. Nevertheless, patients have an obvious interest in their own health care and are well within their rights to request further opinions, particularly if the pathology report is phrased in a cautious manner, or if the diagnosis appears to be serious.
Pathologists should not be reluctant, when asked, to send slides to a consultant. Having another pathologist check one’s work can relieve one of the sole burden of a difficult diagnosis. Well written consultation reports can also serve to teach. Whatever the outcome, the patient stands to benefit from the additional scrutiny. One point on which second opinion requests tend to get stuck is over the question of who pays. A reasonable approach, and the one that many seem to follow, is that when the pathologist feels a need to send the slides out, the department should pay. When, however, the patient or the patient’s physician initiates the request (and the pathologist feels no special need for the consult) the cost should be borne elsewhere.