Most cancers are diagnosed by doctors other than oncologists.  They are diagnosed by family doctors, gynecologists, ear-nose-and-throat doctors, and so on.  Some of these doctors do not want to take the chance of losing revenue, do not want to take the chance of having their patient believe some other doctor is more knowledgeable than they are, do not want to fool around with the inconvenience of a consultant, or honestly believe that they know everything there is to know about cancer.  The patients of these doctors probably are most in need of the second opinion. 

The critical element in successfully treating cancer is in promptly receiving the proper treatment.  In other words, it is doctors and knowledge that successfully treat cancer, not brick and mortar.  We know that cancer is more that a hundred diseases.  There is no relationship between breast cancer and brain cancer other than the name and the fact that they are both rapidly dividing cells.  It is impossible for one general doctor to be informed on the latest and best treatment for every type of cancer.  Furthermore, it is impossible for one specialist, such as a surgeon, radiotherapist or oncologist, to know the very latest and best treatment in his own specialty for every one of the more than one hundred different types of cancer. 

At lunch with a medical oncologist, I asked how often he treated a patient for cancer without a second opinion.  This man, in his sixties, replied that he had never in his career treated a cancer patient without a second opinion.  Furthermore, he always insisted on a second opinion from someone other than a associate of his.  This was for four reasons: 

1.  Cancer is a very serious disease that grows geometrically.  If it is not treated properly the first time, there is often no second chance. 

2.  He is human and could make a mistake. 

3.  Someone else could see something that he doesn’t see. 

4.  Someone else could know something that he doesn’t know. 

I thought this was a profound statement.  I wished that every doctor treating a cancer patient could hear this.  My conclusion from this statement is that any doctor treating a cancer patient without a second opinion is not practicing medicine, but trying to play God. I thought it was only God who was supposed to be perfect, know everything and never make a mistake. 

These thoughts were substantiated in the draft of the May, 1985 publication of the National Institutes of Health entitled Cancer Control Objectives for the Nation 1985-2000.  It states, “The application of the state of the art treatment is complex.  At all levels of the health service delivery system-from the primary care physician who has initial contact with the patient to specialists directing the cancer treatment-physician knowledge is not yet optimal.  That knowledge should include an appreciation for state-of-the-art treatment information and an interest in ensuring early multidisciplinary decision making...For about 70 percent of cancers, optimal therapy derives from multidisciplinary discussions.  The relative rarity of some of the most responsive tumors means that proficient treatment can be maintained only at some major cancer centers...Malpractice considerations may result in physicians selecting “safe” therapy, which neither offers significant risk nor the chance of cure..A major determinant of outcome for most newly diagnosed cancer patients with curable disease hinges on early multidisciplinary treatment planning and the availability of expertise and resources to carry out such a treatment plan.” 

The purpose of the panel is to review the referring doctor’s proposed treatment and approve it or recommend additions or alternatives.  The recommendations of the panel, in addition to being fully discussed in front of the patient, are written down and sent to the referring doctor, with a copy for the patient. 

This idea of holding all discussions openly and frankly in front of the patient and any relatives or friends he cares to bring is unique in the medical world.  Not only do a majority of patients leave with a recommended improved medical treatment, but every patient leaves with an improved state of mind.  They all feel better and have more confidence about what is ahead of them.