Why I Encourage Getting a Second Opinion
Indication for surgical intervention
I am very conservative in my recommendations for surgery. Unless I am convinced that someone needs surgery, I cannot recommend it. I follow this simple rule: I use the same indications for surgery on patients that I would use on my parents, friends, or loved ones. I sleep well at night because I never forget this very simple instruction: treat your patients as if they were members of your family and feel, when you interact with your patients, that all your loved ones are watching you!
So if I’m doing my job right, a second opinion from a decent scientist will only make me look even better to reassure the patient and their family. If I’m offended by a second opinion – then I don’t follow the simple rule I mentioned above. I even encourage my family and friends to get a second opinion about a major surgery.
As a high volume Thyroid Surgeon at this point in my career, most cases have occurred to me. But the surgery is not routine for any patient. Each surgery can be most likely a first for my patient and many things can be in the foreground!
The importance of the initial operation
This patient came in desperate for reoperation, having been operated on elsewhere about 1 year ago for thyroid cancer. Before undergoing the initial operation he had not been checked for the possibility of having infiltrated lymph nodes. During the operation the nerve suffered severe damage resulting in the patient having a permanent hoarseness. In addition, only 1 lobe was removed. The histology showed that she had a 4 cm papillary cancer. The patient had to remove the remaining thyroid in order to undergo additional treatment with radioactive iodine. That was the reason he addressed me. During the pre-operative check-up we performed, it appeared that he had cancer in the other lobe as well as an infiltrated lymph node in the central compartment (mapping) from the area of the removed lobe. The laryngoscopy showed that the nerve had been transected in the previous surgery. The operation I had to perform was removal of the remaining thyroid and central lymph node cleansing from the already operated side.
The risk was quite high since if the nerve that was on the right side was injured, there was a possibility that the patient would not only never speak, he would also have to have a permanent tracheostomy since he would not even be able to breathe. I operated on this patient and completed the operation I had planned with complete success. The result was excellent!
In all types of operations the best results are obtained with the first surgical operation. I am super interested in minimizing the possibility of complications and the radicality of the operation, especially in thyroid cancer patients. While I will always try to reduce the chances of complications to the lowest possible rates, there will still always be risk in any surgery. A thorough and honest discussion with my patient is part of every pre-operative examination and contact with him. In my area of expertise, he is literally my patient’s thyroid, and that’s why he chooses me. I think of this patient of mine from the first moment I see him until he is completely well!