Every patient is entitled to a second opinion before or during treatment. An independent opinion from another doctor or team about diagnosis and treatment is welcome. In a landmark study patient-initiated second opinion recommended changes in diagnosis in 15 per cent of the cases. It also suggested changes in the treatment protocol in 37 per cent of the cases. This is significant.

There are various advantages of a second opinion:

• It confirms or questions the first doctor’s diagnosis and treatment.

• It can provide more information and options.

• It can uncover a potential misdiagnosis.

• It can offer a different perspective.

A second opinion is not recommended in emergencies as there may not be adequate time. Generally, patients seek more opinions when the treatment outcomes are poor or the patient does not respond to the present treatment. Some patients seek opinions to avoid high-risk operations and prefer medical management only.

Every person expects an honest opinion from the doctor. The diagnosis should be accurate and the treatment should be evidence-based. Patients are worried about the cost of treatment and also fear commercial exploitation. The lack of professional trust has affected the medical profession.

Who to approach for a second opinion? It is not always easy to find an answer to the question. Some factors that can be taken into taken into consideration:

• Doctors of the same speciality with similar qualifications and training.

• Records and cure rates.

• Cost effectivity and patient satisfaction.

• Tall claims in social media may not always be helpful. Rather, they can be misleading.

Although a second opinion seems important, it is not without problems. Multiple opinions can increase confusion and result in indecision. In a serious medical crisis, people get worried and may not be able to think rationally.

Sometimes, the opinions of relatives and well-wishers with good intentions may be misleading. If the opinion is sought in the same city, treatment is not significantly delayed. It is also cost-effective.

However, patients incur additional expenses when they travel to other states. Also, there is a valuable loss of time.

Many people are influenced by middlemen. That cannot be recommended.

Patients who have faith in AIIMS, Delhi; Christian Medical College, Vellore; or Tata Memorial Hospital, Mumbai, travel there for opinions and treatment.

Such apex institutions have huge waiting lists for treatment. Under the influence of middlemen, many get treated in smaller establishments without adequate infrastructure as treatment gets delayed. That is unfortunate.

Online opinions are useful in certain situations. It became very popular during the Covid pandemic.

A second opinion is usually given based on certain factors.

• Detailed history

• Clinical examination

• Relevant investigations

Clinical examination is omitted when an opinion is sought or given online. The patient needs to be physically examined. Treatment should not be started based on online consultations. Though many patients are keen on getting an opinion online, they start treatment only after a proper physical examination by a specialist.

During the follow-up, online consultations can be useful in some cases.

“Tumour Board” is a common concept for deciding treatment protocols for cancer patients. Usually, a holistic approach is taken to the diagnosis, treatment and quality of life of the patient. The board meets regularly to offer solutions in complex cases.

A multidisciplinary approach is essential.

However, such meetings are not mandatory for all cases.

A “Tumour Board” has medical, surgical and radiation oncologists among its members but for a comprehensive opinion, other consultants should be present, too.

Oncopathologists, radiologists, genetic experts, nurses, physical and speech therapists and dieticians should be available.

A “Virtual Tumour Board (VTB)” is an innovative concept in cancer treatment. It has been initiated by Tata Memorial Hospital (TMH), Mumbai, under the guidance of National Cancer Grid (NCG).

A second opinion can be sought by any cancer patient being treated anywhere in the country. The main concept is to provide standardised cancer treatment all over the country.

A “Virtual Tumour Board” is a web-based platform accessible to all cancer patients.

Thus, a second opinion can be sought by the treating doctor or the patient. The situations where such an opinion is necessary:

• Requirement of the health insurance company

• The diagnosis is unclear and the patient is being treated symptomatically

• The patient has many medical issues

• The family is unsure about the treatment

• For patient’s satisfaction and peace of mind

Usually, patients get treated where they are fully covered by certain schemes or insurance policies. Patients can get treated in hospitals which have national and international accreditations. It is always a personal decision.

Unlike other metropolitan cities, a lot of patients opt for individual doctors rather than institutions in Calcutta. This has been a trend for decades.

All patients are entitled to a second opinion but it should be assessed judiciously. It is better to keep the treating doctor updated.

Author is a surgical oncologist trained at Tata Memorial Hospital, Mumbai. At present, he is the clinical lead, department of surgical oncology, Narayana Health Cancer Institute