Heart surgeon Thierry Carrel on second opinions

Thierry Carrel, heart surgeon at Berner Inselspital, explains when it is useful to request a second medical opinion and how to prepare for it.

18.09.2018 Daniela Diener

Mr Carrel, when should I seek a second opinion after an initial consultation?

If you haven't understood exactly why your doctor has recommended a procedure, if you are uncertain about why treatment is necessary or if everything is going far too quickly for you.

What is the value of a medical second opinion when it comes to heart surgery?

Requesting a second opinion is not rare for sufferers of heart disease. This is because heart patients often feel no symptoms, even if their disease is already at an advanced or perhaps even serious stage. These patients therefore cannot see why surgery is necessary.

How do you help as a second-opinion doctor?

I always try to explain the complex subject to the affected person in an easy to understand way and try to convince them to have the surgery. In most cases, however, the question is not about whether to have the surgery, but rather about the method – for example, whether a stent or bypass would be best. I discuss the risks, advantages and disadvantages and chances of success with the patient. Patients often particularly appreciate that I have taken the time to explain basic information about the heart and their illness to them.

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And what happens if you come to a decision different to that of the first doctor?

I put forward my recommendation to the best of my knowledge and belief. It is not my intention to bring the patient round to my way of thinking nor to agree or disagree with their doctor. If I come to a different conclusion, I advise the patient to take some time to think – provided that the operation is not urgent. The family doctor can help them decide, for example by asking among their colleagues about the expertise of the two specialists and the reputation of the clinic. This information is easy to find out nowadays.

How often does the second medical opinion differ to that of the first doctor?

Around 90 percent of the time, my second opinion is the same as the first doctor’s. To be precise, if the question is about whether or not an operation is necessary at all, then I agree with the first doctor 90 percent of the time. If it a question of method, I agree in perhaps 70 to 80 percent of all cases. I am convinced that no one should recommend any method of operation as a means of advertising. It can also be the case that I, as a second-opinion doctor, recommend a treatment that does not fall under my area of expertise – for example, that a catheter intervention be performed instead of heart operation. Every party should actually have a say in this.

What is the best way for patients to prepare for the second opinion?

The patient should send all files to the second-opinion doctor in advance, and not just the doctor’s reports or findings, but rather the pictures from the ultrasound or computed tomograph as well. This way, the second-opinion doctor can prepare in the best possible way. The patient should also bring with them a catalogue of questions so that all ambiguities and uncertainties can be resolved. And they should also bring someone with them, so another person can listen to the information too.

Can I request documents from my first doctor?

Yes. But you should also definitely tell them that you need them for a second medical opinion because you feel a bit uncertain – such as in relation to a proposed treatment. This means the process can be transparent and misunderstandings can be prevented. If the patient is after transparency, they must also be as open as possible with the doctor.

So patients don't need to worry that their first doctor will feel insulted?

No. Doctors know that patients nowadays are much better informed than in the past. There is not a doctor today that does not understand the usefulness of a second medical opinion.

So are second medical opinions a modern trend?

I believe so, yes. This service certainly did not exist twenty years ago. Nowadays, patients are more likely to talk about the surgery, read about it in newspapers or on the Internet and therefore find a variety of different figures relating to risks and chances. This can be unsettling, especially if they're facing major operations.

And what would you recommend the patient do after speaking with a second-opinion doctor?

If the procedure is not urgent and the patient is not in a dangerous situation, then they should take some time to come to a decision. They should think about everything in their own time without being pestered by a doctor.

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