•A second opinion can change everything — Prof Morenike Ukpong
•When in doubt, double-check your diagnosis — Prof Oladapo Ashiru
•Doctors should respect patients’ rights to seek a second opinion — NMA
•A second opinion changed the course of my treatment – Patient’s experience
The celebrated case of Dr. Farid Fata, a Michigan oncologist who was sentenced to 45 years in prison in 2015 for medical fraud and misconduct comes into perspective. Fata, who was also slammed with a $17,600,000 forfeiture order, misdiagnosed and mistreated hundreds of patients, many of whom didn’t even have cancer.
Worse still, Fata submitted fraudulent claims to Medicare and private insurance companies for approximately $34,000,000 in fraudulent billings. He admitted to 13 counts of healthcare fraud, conspiracy to pay or receive kickbacks, and money laundering after he fraudulently administered unnecessary and excessive chemotherapy and other treatments, causing the patient’s severe physical and emotional harm.
The impact of his action was colossal. Over 550 patients were affected, some enduring debilitating side effects and emotional trauma. Fata’s case was a shocking example of medical malpractice and abuse of trust and one that highlighted the importance of patient advocacy and holding healthcare professionals accountable for their actions.
The case exposed vulnerabilities in the healthcare system that allowed such a scheme to go on for so long. It was among numerous instances of concerns about medical ethical practices and patient safety worldwide.
This emphasizes the importance of how seeking a second opinion from another doctor can be a valuable step in an individual’s healthcare journey, particularly when facing complex or serious medical conditions. According to medical experts, a second opinion can be beneficial for confirmation of diagnosis, and can provide additional clarity and support for diagnosis.
How a second opinion changed the course of my treatment — Patient’s experience
Andrew, a middle-aged civil servant who was diagnosed with prostate cancer, narrated his experience about the essence of a second medical opinion. He told Saturday Vanguard about the importance of going for a second opinion.
“It was incredible! The key takeaway is that we should always get a second opinion when making medical decisions. When I experienced bone degradation after cancer therapy, a second opinion helped me avoid steroid medication.
“Steroid medication was recommended by one of the top hospitals in Nigeria, so I would occasionally go for injections. I would have the injection once again if the effects wore off.
“At the National Orthopedic Hospital, Igbobi, where I sought a second opinion, the orthopedic specialist prescribed some medication for me. As a consequence, I’ve returned to tennis after a two-year hiatus due to weak bones. I’m now feeling fantastic and performing well. For me, prayer was effective.”
Speaking further, Andrew recalled how only recently, a patch was discovered in his right eye, which was described as a cyst.
“I wasn’t diabetic and the doctors wondered the cause of the cyst. Aylea injection into the eye was prescribed by a doctor in one of the best eye hospitals in Nigeria. Each shot of the injection was N800,000, and I was scheduled to take three shots in three months. But another doctor suggested I seek a second opinion from a retina consultant.
“One week later, I saw the Indian consultant who said I didn’t need the Aylea injection, which is usually injected into the eye. Some eye drops were prescribed. For me, it was not even about the cost of the injection, but the wrong diagnosis, which could have caused another problem for me. So, let’s all seek a second opinion and, if possible, a third opinion in healthcare,” Andrew advised.
In Andrew’s case, another doctor had a different perspective that helped to refine the initial diagnosis and this helped to gain a more comprehensive understanding of his health condition and the potential treatment available. His condition improved tremendously after three months application of the eye drops recommended by the retina consultant.
Benefits of a second opinion
A second opinion helps to establish early detection of misdiagnosis. Patients must be informed and proactive in their healthcare decisions, asking questions and seeking second opinions when necessary. Some of the Fata’s patients who sought a second opinion escaped his callous actions.
Nigerians shun 2nd opinion
Although there is no comprehensive data on the number of Nigerians who seek a second opinion from a doctor, the 2018 Nigeria Demographic and Health Survey, NDHS, notes that 14 percent of women and 12 percent of men in Nigeria reported seeking a second opinion from a doctor in the past year.
From the study, seeking a second opinion was more common among people with higher levels of education and income.
Another study, published in the Journal of the Nigerian Medical Association in 2019, found that only 25 percent of patients seen at a tertiary care hospital in Lagos had sought a second opinion from another doctor before coming to the hospital. The study also found that the most common reasons for seeking a second opinion were dissatisfaction with the diagnosis or treatment plan provided by the first doctor and a desire for more information about the patient’s condition.
For instance, Saturday Vanguard findings showed that some patients fear that seeking a second opinion will be perceived as a sign of distrust or disrespect for their first doctor. This fear often prevents them from seeking the additional information and support that they need.
Many Nigerians are not aware of the benefits of seeking a second opinion and do not even understand that it is a common practice and that it can be very helpful in making informed decisions about their healthcare.
What the NMA says
The Nigeria Medical Association, NMA, which is the umbrella body for medical practice in Nigeria, supports the provision of second opinions and encourages doctors to comply with the Code of Medical Ethics and the Association’s guidelines. The provision of second opinions recommends that doctors should respect the patient’s right to seek a second opinion.
Section 42 of the NMA’s Code of Medical Ethics states: “When a patient is referred to a fellow doctor for a second opinion, or for investigation, it is culpable misconduct for the doctor so consulted to take over the continuing care of the patient so referred.”
The interpretation of this section is that the doctor who provides the second opinion should not assume responsibility for the patient’s care unless the patient and the referring doctor agree to it.
The NMA also encourages doctors to provide patients with the option of seeking a second opinion. The Code of Medical Ethics states: ”it is normal professional courtesy for the consulted doctor to communicate a comprehensive report on the patient to the referring doctor. Failure to comply with this norm constitutes improper conduct.”
Barriers
There are several barriers to seeking a second medical opinion in Nigeria. The first barrier is finance. The cost of seeking a second opinion is often a hindrance and a major deterrent for many Nigerians. Consultation fees in Nigeria can be relatively high depending on where the treatment is being sought.
The average cost of seeking a second medical opinion in Nigeria varies significantly depending on the location (urban or rural), the type of healthcare facility (private or public), and the specialist involved. The cost also depends on the complexity of the medical case.
Saturday Vanguard findings reveal that consultation in public hospitals ranges from around N2,500 to N7,000, but there are longer waiting times and limited access to specialists. This is compared to an average of N10,000 to N50,000 or even higher in private health facilities depending on the specialist and location. These are in addition other expenses such as diagnostic tests, additional consultations, and transportation costs.
The lack of insurance coverage is also there. Most health insurance plans in Nigeria do not cover the cost of second opinions or at best offer limited coverage. So in most cases, the patient pays out of pocket for multiple consultations.
The shortage of healthcare resources also contributes to the malady, forcing patients to be pressured into starting treatment without seeking a second opinion, especially for serious or chronic conditions.
A second opinion can change everything — Prof Morenike Ukpong
A professor of Paediatric Dentistry at the Obafemi Awolowo University, OAU, Ile Ife, Prof Morenike Ukpong, noted that with the growth in self-care, seeking second medical opinion is important to ensure thorough and well-informed decision-making regarding one’s health.
Ukpong, who is a Researcher/Lecturer and clinician with the Obafemi Awolowo University Teaching Hospitals Complex, OAUTHC, said a second medical opinion should not be overlooked even in routine diagnosis.
“A second medical opinion is important when dealing with serious medical conditions, especially those requiring major interventions or surgeries. These include when managing chronic illnesses that require long-term management, when the initial diagnosis is unclear, if there are conflicting recommendations among healthcare providers regarding the treatment approach, or when undergoing invasive procedures or surgeries.
“In addition, anytime a patient is dissatisfied with the current treatment or is not experiencing the expected improvement, seek a second opinion. When high-risk medications are prescribed, especially with potentially severe side effects, seek a second opinion.”
Ukpong decried the poor level of awareness among Nigerians. In her recommendation, she called for public sensitisation to bridge the knowledge gap.
“I think awareness is poor as is the medical awareness generally. I also think that those with higher educational backgrounds may be more aware about seeking a second opinion, including reading up about their ailment, and treatment options and exploring this with their medical practitioners even when they seek a second opinion,” she urged.
When in doubt, double-check your diagnosis —Prof Oladapo Ashiru
In the view of a renowned scholar and co-founder of In Vitro Fertilisation, IVF, in Sub-Saharan Africa, Professor Oladapo Ashiru, a second opinion is crucial to medical diagnosis.
”Any procedure that you want to do, especially when it involves surgery, healthcare or some invasive procedure or cancer, has far-reaching consequences such that the patient should be able to always opt for a second opinion, so that it can conform and reinforce the opinion of the first medical intention, or to disagree.
“Ethically the doctor is not supposed to discourage a patient that wants to seek a second opinion or wants to go to another centre for treatment,” he noted.
Ashiru, who is the Secretary-General of the International Federation of Fertility Societies, IFFS, and is well-known for his important contributions to the field of reproductive healthcare, remarked that
“It is very important all over the world even in the developed countries a patient would always ask for a second opinion. There have been cases of patients who were told that they had cancer only to realise that they did not have cancer, and many like that. So a second opinion is essential.”
Ashiru argued that for somebody going through surgical treatment, a second opinion is critical.
“I have a patient in the US who got pregnant but along the line the pregnancy stopped and the baby stopped growing. She was being asked to either do a medical evacuation, that is to take medication to expel the fetus, or to do dilatation and evacuation.
“She consulted and sought opinions from other specialists about what was best to do, and the doctor in the US allowed her at that time to make her decision. Eventually, she opted to do dilatation and evacuation which was confirmed by the various opinions because she would get it over and done with. Whereas medical evacuation might fail and would still require evacuation. So these are things that are encouraged in medical practice.”
Ashiru lamented that Nigerians are not well informed. “This is the major problem with many people. A large percentage of our population does not read and is not informed, and only a few people who are informed can take the opportunity of such practice. We need to do a lot in educating the population about health matters,” he remarked.
The bottom line
Don’t be afraid to ask your doctor questions. The power of challenging medical diagnosis lies in the hands of Nigerians through insisting on a second opinion. A second opinion usually helps prevent fraudulent claims, protect patients from potential financial burdens, provide emotional and psychological relief, alleviate anxiety and fear, and improve patients’ mental well-being. The importance of patient advocacy, awareness of misdiagnosis risks, and proactive engagement in healthcare decisions cannot be overstressed.
Every medical doctor is expected to provide patients with information about their options and also to facilitate the patient’s referral to another doctor. In addition, the doctor(s) who provides the second opinion must also share their findings with the referring doctor, even if the patient chooses not to follow their recommendations.
To address these barriers and encourage more Nigerians to seek second opinions, there needs to be a shift in attitudes and a greater emphasis on patient empowerment. Government and insurance companies should also take steps to make second opinions more affordable and accessible.
[Vanguard]