Choosing the Right Doctor: Why a Second Opinion Matters

September 2024

Issue 15: September 2024  

In This Issue:  One decision can change everything. This month, I reveal how getting a second opinion was the turning point in my medical journey—and it could be the key to unlocking better care for you or a loved one. 

Choosing the Right Doctor: Why a Second Opinion Matters

Navigating medical decisions can be overwhelming, especially when you are worried and have numerous options. Meeting with more than one physician can give you valuable perspective on your condition and your choices. You want a physician who will understand you and meet your unique needs. 

Recently, I had cataract surgery. I realize cataract surgery is no big deal—it’s a common procedure with few risks and a high success rate—but nevertheless, I felt far too young to be having cataract surgery. What made it even worse was that all my life, I have been phobic about eyeballs. I’m not phobic about anything else, just eyes. I never wore contact lenses because I couldn’t touch my eyes. Even in medical school, the eyeball was the only part of our human anatomy course dissection that gave me the heebie-jeebies! And cataract surgery is nothing if not a whole bunch of reasons for doctors and their assistants to get really close to your eyeballs.   

First, some clinical info: a cataract is a cloudy area inside the eye lens that you can’t easily see through. When the opaque lens is removed, it is replaced with a spiffy new lens. Insurance will pay for standard surgery and a basic (monofocal) lens. Other lenses are considered premium, and there is an out-of-pocket charge of several thousand dollars for a premium lens.    

 Approaching the surgery, aware of my squeamishness, I imagined embarrassing myself. It seemed important that I maintain a dignified composure, one aligned with my self-image as a calm, competent, down-to-earth professional. I feared being an out-of-control ball of nerves.  So, for a host of reasons, I was nervous about this procedure. I wanted to be an easy patient.   

I failed miserably.   

I preop, a tech tried to put my eyedrops in. When I couldn’t keep my eye open while staring at the looming eye drop bottle, she tried to pin me down and force my eye open. I wasn’t a fan of this approach and squirmed away. She looked disgusted and muttered under her breath. I said (probably too loudly) that I’d rather have a gynecologic exam than get eyedrops. I briefly wondered if I could take her in a fight (and decided that I could).    

The nurse came over, then the doctor. You know you are being troublesome when three professionals simultaneously stare at you. Then, both the doctor and the nurse were incredibly kind to me. The nurse said he understood my fears and that we should all be afraid of things touching our eyes. My irrational fear was reasonable. He was gentle and reassuring. The doctor joked that he’d feel the same way if he ever needed treatment for bladder cancer. I calmed down. The eyedrops went in.    

Their kindness transformed an experience that could have been a nightmare into a positive one.  When you are feeling vulnerable, and someone treats you kindly, you are grateful and never forget it.  

None of this happened by accident. My experience is worth scrutinizing further because there are lessons to be learned.   

 I have an excellent optometrist in my small hometown, two hours north of New York City, who recommended a local ophthalmologist for my cataract surgery (the one I ended up using). I didn’t know this ophthalmologist, and after asking around, nobody had heard anything negative. At the time, I wasn’t planning on using him, so I figured it would be okay to start with him.    

Dr. Steinberg’s physical office is best described as meh: a clean, small, ordinary space. His waiting room held people from mixed economic circumstances. Happily, his staff was warm and friendly. I watched him check with them between patients and regularly send staff off for breaks. “This is a good guy,” I thought to myself.   

After I completed a series of screening tests, Dr. Steinberg spoke with me about the surgery and answered my questions. I didn’t schedule surgery because I had a visit to another doctor planned. I was going to the mecca.    

Two weeks later, I went for a second opinion at a top eye center in Manhattan (my insurance pays for second opinions, and yours may, too). This place was affiliated with a top New York hospital, and the waiting room held fashionably dressed Manhattanites. But it was also a total mill, designed for fast turnover and upcharges.   

The staff did the same screening tests again, even though I had had them a few weeks before. Other tests were layered on, including one for an esoteric eye disease that I have no risks for—but which this ophthalmologist specializes in treating. (Why? Perhaps because he is over-eager to find cases, and perhaps because—let’s face it—his practice could bill my insurance company for the test.)   

During our visit, even knowing that I was a doctor, the well-rated Manhattan ophthalmologist rushed me. He said he offered a wide choice of lenses (but didn’t have time to explain). When I asked if my astigmatism could affect my lens choice, he said that if I wanted my astigmatism fixed, I’d need a type of premium lens called a toric lens. He offered no further explanation other than to inform me premium lenses cost $1,200 to $3,000 more.   

I tried to ask a question, but he said we had to discuss laser versus standard surgery. He wanted my agreement to use a laser on me (a “bargain” at $1,500). I had read that there was no difference in outcomes between laser and standard cataract surgery. When I asked if this was true, the doctor confirmed that it was. When I asked why he was recommending laser surgery, he answered truthfully: “Because,” he said, “it saves me time.” He then instructed his assistant to play a promotional video from the laser manufacturer and walked out. I watched the video and waited. His assistant returned to escort me out.  I said that I still had questions, but apparently, my time with Dr. Fancypants was up.   

After I left, I wrote down my list of remaining questions and did more research online. I wasn’t sure what kind of lens I wanted: Toric? Unifocal? Multifocal? Extended Depth of Focus? Light Adjustable? I wanted to ensure I picked the right lens since it would be in my eye for forty years (I hope!).    

I called his office and asked for a call back from Dr. Fancypants because I had more questions. About a week later, I received a call from an assistant who tried to be helpful but wasn’t a doctor (or a physician assistant, or a nurse). She said the doctor had written that I would be having cataract surgery with toric lenses implanted in both eyes.  But I was there for one eye. And I hadn’t settled on which kind of premium lens I wanted.

 Then, I left the same message for Dr. Steinberg, my local doctor He called me back that evening—at no charge—and reviewed the options with me. There was zero upsell.  

Toward the end of our chat, I said I was thinking of a monofocal toric lens. He then explained that I didn’t need a toric lens because I had lenticular astigmatism, not garden-variety astigmatism. A standard monofocal lens would cure my astigmatism; there was no need to go with a premium lens.    

It became a no-brainer. Here, I had a decent, honest professional, a doctor who based his recommendations on my needs and wishes. I signed up to have my surgery done locally, with a monofocal lens entirely covered by insurance. I had been prepared to spend thousands of dollars to get the “best” lens and surgery. And it turns out that I didn’t need to do so. I was grateful. Fancy isn’t always better. Being seen as an individual is much better.   

Now, there are times when one wants to travel for a superspecialist. You do not want your heart transplant done at the nearest community hospital. But cataract surgery is a common procedure. It’s an extremely low-risk procedure. My local doctor has done thousands.    

That second opinion was worth my time. Getting a second opinion helped me refine my expectations, both what I wanted and what I didn’t want. And it would have been worth it, even if I’d had to pay for that second opinion. Whether an NFL football ticket or a Taylor Swift ticket, people pay astronomical prices for luxuries. But too often, we hesitate to pay for a second opinion, which is a mistake I will discuss in another newsletter.   

Email me with your questions, comments, or subscription requests at gm@mymdadvisor.com. I’d love to hear from you.

Warmly,

Gerda Maissel, MD, BCPA

Dr. Gerda Maissel, Author

Dr. Maissel is a Board-Certified Physical Medicine and Rehabilitation physician and a Board-Certified Patient Advocate.