It is often said that no one should have spine surgery unless they receive a second opinion from another surgeon. On the surface, this advice would sound like good old common sense, as two opinions are better than one.
However, there is a trap in this line of thinking.
When a patient sees a physician for a second opinion, this next opinion has a tendency to always sound smarter than the first opinion. This is a well-recognized phenomenon, but in reality the second opinion may not be the best one.
When to Consider a Second Opinion
So, the question is when should you get another opinion?
- Certainly if you are not comfortable with the first physician for any reason, then seeing another surgeon for an opinion is a good idea.
- If a surgeon cannot answer questions about the rationale for a proposed procedure or is vague on the surgical plan, another opinion is a good idea.
- If your personal goals are different from the surgeon’s, e.g. if you really want to avoid surgery to treat your pain, and the surgeon is saying that surgery is really your only option.
- If you suspect that the initial referral was made on the basis of economic interests rather than who is best suited for your surgery, go for another opinion. (Referring physicians tend to favor local surgeons who will do the surgery in a local facility, especially if they are in a multi-specialty clinic. This is not saying that these physicians are not capable, but that there is a possibility that the first referral one receives may not be the best.)
- Another time it is good to get a second opinion is if the initial back surgery did not work and another surgery is being proposed. This advice is especially true if it involves fusing further segments of the spine. Often, if the initial fusion surgery does not work, further surgery will not be helpful. Only in very specific circumstances (i.e. pseudoarthrosis) is further surgery likely to be beneficial.
- There are times when a surgeon will ask a patient to get a confirmatory opinion prior to proceeding with surgery. In these cases it is often best to let the treating surgeon pick the second opinion as they are best able to determine whose opinion they would value.
Otherwise, picking a surgeon for a second opinion is often difficult. As previously stated, the goal is to get an opinion from a skilled, experienced and ethical surgeon. While it is not perfect, word of mouth is probably still the best measure as to who could be helpful in the second opinion process. This is, however, still a relatively arbitrary process.
Online Second Opinion Services
In addition to physically going to a surgeon for a second opinion, there are now some online second opinion services available, including services from surgeons who will look at your medical information online and provide a second opinion, as well as radiology services, with radiologists who view your x-rays, MRI scans, etc., and provide a second opinion.
The online services have the potential benefit of obtaining an unbiased opinion (ie the online service is not going to benefit if you have the surgery), and the obvious drawback is that they do not evaluate you and your condition in person.
The Surgeon Interview
The best thing for a patient seeking another surgical opinion is to keep an open mind. You need to be as judgmental about the second opinion as for the first, and need to grill the second physician even further than the first.
At a minimum, you should cover these topics with the surgeon:
- Focus on the surgeon’s experience with your specific type of back surgery
- Find out what the surgeon's past outcomes with that type of surgery have been
- Ask what are the alternatives to a proposed procedure
- Ask what is the expected natural history of the patients’ condition if they do not have the procedure
- Learn exactly what the risks and possible complications of the procedure are
- Ask if the surgery doesn’t work, then what would be the subsequent plan?
For a more complete surgeon interview guide, see 38 Questions to Ask Your Surgeon Before Having Surgery.
As a general rule, be very wary of second opinions from surgeons who:
- Make claims that sound too good to be true. There are no magical cures (i.e. painless surgery)
- Are toting unrealistic expectations
- Are overly dependent on "cutting edge" technologies
As a final note of advice, the worst thing to do is assume the second opinion is automatically going to be better than the first. Keeping an open mind will prevent you from falling into this trap. And if you’re still not sure, get a third opinion.
- Further Reading: Orthopedic Surgeon vs. Neurosurgeon for Spine Surgery