The Foglight - The Value of a Second Opinion (or Even a Fifth): Taking Control of Your Health and Making Fully Informed Decisions

February 2025

Issue 20: February 2025 

In This Issue: We continue last month’s discussion of Honey Bunny’s hospitalization, highlighting the importance of obtaining enough information —navigating the system, asking the right questions, and actively understanding each doctor’s recommendations to ensure that a fully informed decision can be made.

The Value of a Second Opinion (or Even a Fifth): Taking Control of Your Health and Making Fully Informed Decisions

Last month, I told the story of my husband’s experience with hospitalization and the multiple interventions I made to prevent medical problems from going off the rails. After his ginormous prostate prevented his bladder from emptying fully, he developed kidney failure from the urine back-up (a condition known as obstructive nephropathy). Click here if you’d like to read the January edition of The Foglight about the little mistakes that happened during the hospitalization.  

I want to pick up where we left off because even with me by his side, asking questions, we still had to rely on a surgeon—a urologist—to solve his problem for good. And that part of the journey was a reminder of a key lesson in dealing with health care, one I have addressed before: get multiple opinions. 

There are a number of surgical procedures to reduce the size of the prostate. When prostates are relatively small, drugs can make a difference, as can stents. But in his case, to fix the problem and prevent further kidney damage, he knew he needed surgery.  

The first doctor we met during his hospitalization was actually not a doctor at all, but two (rotating coverage) physician assistants from a local urology practice. If the urologist him- or herself saw my husband, neither of us recalls meeting him or her. After five days, there had been no discussion of the plans for the Foley catheter in his bladder (something that Snookums was not a fan of). He wanted it out now. I suspected he would need to keep it in until surgery, but I wanted him to hear the plans for the Foley from a urologist. It seemed better to have an official person tell him he was in for at least a month of having a tube stuck into his favorite, um, spot. But there was also no discussion, or even a preview, of the options to treat his large prostate.  

On his last day in the hospital, we asked to see someone–anyone–from the urology service. Nope, no one was available to talk. We received a message to go home and schedule a cystoscopy with their practice.  

Maybe a cystoscopy was the correct next step, but it wasn’t immediately obvious to me why using a scope to look inside his bladder would be the very next thing to do. We wanted to understand the necessity before scheduling. Just the thought of putting a scope up there made Hubby cringe; we wanted to know why that was needed as the first step. Had we run into a protocol, or was there something about his situation that made a cystoscopy necessary now? We wanted to make an informed decision.  

And what about that thing—that big ole tube —sticking out of my husband? What were the plans for that? No communication. So, we decided to skip this local urology practice. 

Through my network, I found another practice with a recommended doctor. When Honey Bunches showed up for his appointment, he was seen by a very nice urologic nurse. But no doctor. She said the next step wasn’t a cystoscopy, but rather two voiding trials. In a voiding trial, they remove the Foley catheter and see if you can empty your bladder enough to be catheter-free. Once he had done this voiding trial on two future days, then he would be allowed to see the doctor.

I knew that a) his extreme urinary retention meant he would probably fail a voiding trial and b) his kidneys were still not working well. This meant that, even if he did well once, it was unlikely to be safe to remove the catheter because that would risk a recurrence of his retention and further kidney damage. I asked if we could plan one voiding trial and a doctor’s visit on the same day. Nope. We were expected to take a second, third, and then fourth day off from work in order to be allowed to have a conversation with the urologist. Next.  

Could I have done an end-run and contacted the doctor myself? Sure. But that’s not my style. If the practice is so protocol-heavy and non patient-centered, I knew there were other fish in the urologic sea.  

So, we found another urologist. My husband saw the doctor on the first visit. Yay! That doctor recommended either a new procedure that uses water to blast away the prostate or an older procedure that comes with a significant risk of side effects. To his credit, this doctor disclosed that he owned stock in the company that makes the water blaster. Just because the doctor had stock in the company and could benefit financially from having his patients undergo this procedure, did not mean it was the wrong choice. But it was worth bearing in mind. But, he seemed like someone selling us something. My honey, fond of nicknaming his doctors, called him “the used-car salesman.” 

The following week, my man saw a doctor who worked at a major academic hospital and didn’t have stock in anybody’s urology equipment company. He recommended a different procedure, one that used lasers to reduce the size of the prostate. He recommended the same older “gold standard” procedure. The laser is also a relatively new surgical option, but less new than the water blaster.   

We looked up outcomes to choose between the laser and the water blaster. The outcomes were quite similar—according to the research, one option had a slightly higher risk of incontinence, another had a slightly higher risk of sexual side effects. Both clearly had less side effect risks than the older “gold standard” procedure.  

Honey Boo was on the fence between the laser and the water blasting options. He didn’t want the older procedure. Wanting advice, I phoned a friend, a urologist who lived out of state, I needed help breaking the tie. He was a fan of the laser procedure. “We are not even doing the laser here,” he said. “If you have a guy good at the laser, hands down, go with that.” 

When I went back to Honey Bun, this was music to his ears. He said, “Between the recommendation from the doc you know, and the water-blaster doc acting like a used-car salesman, let’s go with the laser.” 

He ended up having the laser procedure done at an academic hospital in a big city. It was a pain in the neck to get there, and it was expensive for me to stay overnight in a hotel while Honey Bunny was hospitalized. 

But while he was hospitalized at Academic Fancy-Pants Hospital, there were no mistakes. Not one. I’ll say it again. Not one mistake that I noticed. And I notice a lot.  

Hubby recovered from his laser surgery. He happily tossed all of his Foley catheter supplies. His kidney function returned to normal. His energy came back. And as a nice surprise, his blood pressure and blood sugar numbers normalized. Now, he’s taking almost no medication. We think the cause of his pre- catheter rising blood sugars and blood pressures was his ridiculously distended bladder. His body was probably saying Oh my god, Oh my god and sending out all kinds of signals that something really bad was happening. That caused his blood pressure to shoot up. His cortisol, a stress hormone that raises blood sugar, was likely high, too.  

In a prior essay about my cataract surgery, I pointed out that a fancy pants practice is not always the best; sometimes, your hometown doctor is the way to go. However, as we learned from Sweetie’s experience, the opposite is also true: sometimes, the academic hospital in the big city is better.  

In his case, access to a new, better surgery at a hospital with excellent clinical safety systems, made a huge difference. While it was inconvenient to deal with the big city, it was totally worth it.  

 In either case, the lesson is the same: an additional opinion (or several) can lead to better outcomes. It’s worth your time to choose your surgeon carefully.  

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

Wishing you peace and understanding in your healthcare journey,  

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.