SECOND MEDICAL OPINION

Throughout my twenty years as an Internist, I have witnessed incredible advances in medical science. However, due to a variety of factors, patients are still not benefiting from a more focused, precision-based model to treat their ailments. My view of traditional medicine has evolved to a more holistic, yet focused view in reviewing patient issues outside of conventional evaluative methods.

cropped static1.squarespace.com Afshin nasseri

The Mindfulness Process

About Second Medical Opinion

The United States spends more on health care than other developed nations yet have higher medically related deaths and shorter life expectancies compared to other developed countries.

Patients in the United States pay more for prescription drugs, clinic visits, procedures, diagnostic tests, and hospital fees. The unsustainable nature of such expenditures has led health policy organizations to advocate for the “High Value Care” approach to reduce these costs.

Throughout my twenty years as an Internist, I have witnessed incredible advances in medical science. However, due to a variety of factors, patients are still not benefiting from a more focused, precision-based model to treat their ailments. My view of traditional medicine has evolved to a more holistic, yet focused view in reviewing patient issues outside of conventional evaluative methods.

I invite you to start a dialogue with me regarding your unresolved illnesses, so I can help you improve your quality of life. I work with a network of physicians across specialties, and as a team, we will be able to address all your questions or concerns.

Please note, my services are not traditional telemedicine designed for acute ailments. I am your consultant in your pursuit of a healthy life, and I will review all your health records via HIPAA-compliant confidentiality and make detailed recommendations.

What is Second Medical Opinion?

A second medical opinion from another heath care provider can assist you in making informed decisions, put your mind at ease, and ultimately, save your life.

Medical science is highly dynamic, newer approaches may provide fewer side effects and shorter recovery time. training and experience of Physicians vary for conditions and treatments.

Medicine is not an exact science. Tests may prove inconclusive and different approaches may be effective.

Second Medical Opinions can answer questions such as:

Is there a physician with specialization for my condition who might have a different view or something to add?

Are other options available for treating this condition? What are the pros and cons of each, and which one is best suited for me?

Are other doctors in agreement with the diagnosis and treatment plan?

If test results of test are inconclusive, should they be repeated or are there other ways to find out?

Some patients hesitate to pursue a second opinions even when they are encouraged to. The hesitation comes from one of the common misconceptions about second opinions outlined below:

#1: My doctor might get upset.

Doctors generally welcome other doctors’ opinions. The American College of Surgeons says that getting a second opinion before surgery is good medical practice, and doctors should not be offended when a patient requests it.

The Center for Advancing Health suggests saying something like this:

“This is a big decision for me, and I would like to talk with another expert or two so that I feel completely confident in our treatment plan.”

#2: It will be expensive.

Health insurers generally cover second medical opinions for medically necessary procedures. Some health insurers may even require you to get a second opinion. In certain complicated cases they may pay for a third opinion.

#3: It is so hard to see another doctor.

 It takes so long to get an appointment—and there’s so much running around, and paperwork, phone calls, insurance authorization and so on.

Choosing the same healthcare system, will facilitate the process. Second opinion program staff can help identify a doctor or doctors; collect medical records and other test results, images, and pathology slides for you; and send them to the second provider. 

In a different health care system, it may take a little longer. So, do your homework on their program to make sure the process will be as quick and easy on you as possible.

#4: My medical condition is not life threatening, so I shouldn’t bother.

Your condition – life-threatening or not – you should feel comfortable and confident with your diagnosis and treatment.

Importance of annual wellness visits

Yearly appointments can reveal vital health information for both you and your doctor.

It does not take much time, and it is a great way to educate you about your present and future health. It is usually covered by your health insurance.

men should still have one every year as it remains an important part of primary care, according to Dr. Asaf Bitton, executive director of Ariadne Labs and primary care physician at Harvard-affiliated Brigham and Women's Hospital.

"For many men, this is one of the few extended opportunities they have for an in-depth conversation about their health," says Dr. Bitton. "The meeting helps both the patient, and the doctor address concerns, look at preventive measures, and create health goals and expectations together."

Measuring value

The traditional annual physical exam that focuses only on routine measurements and tests has drawn criticism in the past. An often-cited JAMA editorial from 2015 suggested they offer little value to people and do not increase life expectancy.

"But the key word here is value," says Dr. Nasseri. "This can mean different things to different people."

For many men, the annual wellness visit is more than a snapshot of their current health. "Over time, men need the chance to identify and reflect on what is important for their health and what goals they want to accomplish," says Dr. Bitton. "Without this regular interaction with their doctor, they can end up running around with no clear idea of where they are in terms of their overall health and the best ways to reach their new goals."

What are the benefits?

The wellness visit usually includes measuring your height, weight, blood pressure, and heart rate, and your doctor may also do a physical exam. (You might be asked to give a urine or blood sample, too.)

"This is information many men don't regularly get on their own. They don't know what is ideal or whether there have been significant changes," says Dr. Bitton.

Dr. Afshin Nasseri, believes the visit is a chance to review healthy and potentially unhealthy lifestyle choices, such as diet, exercise pattern, smoking status, and alcohol use. Beyond these basics, many primary care doctors now screen for common behavioral health problems, such as stress, depression, anxiety, and sleep issues. They also may review other health-related social needs like home safety and transportation.

An annual wellness visit is also an ideal time to discuss the need for specific screening tests, some of which you may not have known about. Examples include an abdominal ultrasound for men ages 65 to 75 who have ever smoked and a chest CT scan for some current and former heavy smokers.

"You can have a conversation with your doctor about the benefits and risks of these tests, which helps to make a shared decision about whether and when you should have them," says Dr. Bitton. "This way you become better informed and engaged about your ongoing health."

Questions to ask your doctor.

Consider having a family member or close friend come along, especially if you get nervous at the doctor's office or have trouble remembering everything the doctor says.

Come prepared with your questions written out.

Inquire if there are preventive measures you should follow, such as vaccinations, screening tests, dietary changes, and exercise routines.

Ask what any prescribed medication or procedure is for, what it will accomplish, the risks and benefits, the potential side effects, and if there are alternatives.

Fill out or update your health care proxy forms, and if appropriate, your Physician Orders for Life-Sustaining Treatment (POLST) form. This ensures all your health care professionals will know whom to speak with if you cannot and provide only the treatments you wish to receive.

Personal relationships

An annual visit also helps you build a stronger relationship with your doctor and hopefully allows open communication. Do you feel a connection with your doctor? Does he or she ask in-depth questions, and better yet, encourage you to do so?

"It's important that your doctor takes time to understand your concerns and answers all of your questions," says Dr. Bitton. Also, your physician should be someone with whom you are comfortable talking about even the most sensitive subjects.

Even if you consider yourself healthy and do not have any known medical problems, an annual wellness visit is still beneficial.

"You can always learn something new, even if it's good news about your health," says Dr. Bitton. "This shows that you are on the right track, and the experience offers motivation for you to continue being proactive. You owe it to your health to devote about an hour or two, once a year, to your long-term well-being."

Your primary care physician will be best suited to answer your questions about controversial issues, states Dr. Nasseri.

Should I continue PSA screening for prostate cancer?

As reported by Harvard’s April publication by Doctor Howard LeWine, Editor in Chief, Harvard Men's Health Watch “some guidelines suggest stopping prostate cancer screening after age 70, the decision to continue depends on your general health and life expectancy. The reason: Most prostate cancers are low-grade and will not shorten a man's life or diminish his quality of life. On the other hand, diagnosing higher-grade cancer at an earlier stage could lead to treatment to keep the cancer from spreading.

In the past, a man with a high or rising PSA level would have to choose between having an immediate prostate biopsy (to locate any cancer and assess its severity) or living with some uncertainty. Today, other tests can help predict the presence of cancer, especially cancer that is more likely to spread. Examples include MRI (magnetic resonance imaging), specific subtypes of PSA blood tests, and urine testing for specific genetic markers. For men who do opt for prostate cancer screening but may not want immediate treatment even if cancer is likely, the two main strategies are watchful waiting or active surveillance.

Watchful waiting. Watchful waiting either before or after a biopsy means you don't get regular PSA tests or other monitoring. Only if symptoms occur would you have further diagnostic testing to determine whether and how to treat the symptoms.

Active surveillance. An active surveillance strategy requires a prostate biopsy first to identify the cancer's size and probability of spreading. High-grade and many intermediate-grade prostate cancers don't qualify for active surveillance because treatment usually begins right away. However, this strategy is an option for men who would be comfortable with close monitoring for low-grade cancer. Active surveillance involves more frequent PSA testing (to look for any rise in the level over time) and likely periodic prostate biopsies. Your doctor might order an MRI or a urine test for genetic markers to determine when a repeat biopsy is needed. When evidence arises that the cancer has become more active, then treatment would begin.

Studies comparing men with low-grade prostate cancer who choose active surveillance rather than immediate surgery or radiation show similar outcomes and life expectancy. By choosing active surveillance, a man can delay or even avoid treatment side effects, such as erectile dysfunction and incontinence. The downside is the small risk of delaying treatment of a cancer that grows faster than expected.”