Second opinions

Vinay Prasad, MD MPH; Physician & Professor
Hematologist/ Oncologist
Professor of Epidemiology, Biostatistics and Medicine
Author of 500+ Peer Reviewed papers, 2 Books, 2 Podcasts, 100+ op-eds.

Follow me on:
Twitter @vprasadmdmph

[tanakaba]

My Dad stopped eating and lost weight over the course of a few weeks, eventually going to the hospital for two weeks after he became faint and passed out. On the first day at the hospital, after tests, they found the lining of his colon was sloughing off. The reason he lost appetite was because his body couldn't pass the food. First doctor said they would have to remove part of the colon, and he'd have a colostomy bag the rest of his life. Dad declined. Second day, doctor came back for a signature. Declined. Third day, second doctor, same plan. Declined. This went on for about a week.

Finally, fourth doctor comes in with an idea. Stop taking some of the medication Dad takes from having an organ transplant. Next morning, Dad has an appetite and eats breakfast. Turns out, insurance had made him switch to a generic and some kind of allergy/side effect was causing the damage to his digestive system. They got him on a replacement medication, and he was released shortly after.

[donaldlewis]

Went to Mayo Clinic (living in Rochester at the time). Husband was diagnosed with HIV. They even announced it at the front desk when they were making an appointment for follow up. The test was indeterminate when I read the labs. Went to the local Olmsted Medical Center community center and they did confirmatory tests which were negative for HIV. Will never forgive Mayo for the stress they caused over those few weeks/months.

[autumna]

Dr. Prasad, I appreciate your insight and know that you are a thoughtful and caring MD. I have learned so much from watching your videos. I am a RN at an academic medical center. Worked there for over 35 years. I have seen good MDs and not so good. Love your candor and expertise. I know you are one of the great MDs at your facility!

[lauratroyer]

I had a very rare cancer that no one at the Cleveland Clinic had ever seen. I got very good care from other gyn oncologists in Cleveland and Akron because they were willing to research and reach out to others about my treatment. I got very good care and have been cancer free for 10 years.

[Logi_Queenie]

pharmaceutical companies ARE the medical field at this point in America

[Vantasticviews]

I know nothing about cancer (and hope I never have to learn) but I so appreciate your honesty, integrity, and most of all, your willingness to call it like you see it. Rock on!

[Titor]

In my experience the large cancer center had MUCH better quality of care and quality of life.

Stage 4 Burkitt Lymphoma survivor here - a second opinion at MSK in NYC was a huge upgrade for me. My local hospital suggested a more toxic chemo R-CODOX-M/R-IVAC and wanted to start the regimen in a couple weeks due to scheduling and overall the local oncologist seemed nervous/uncertain about my case. The second opinion at MSK proposed to start chemo the very next day and they cited research to show that there's a better regimen with less toxicity DA-R-EPOCH. MSK has relationships with other hospitals to get me admitted that next day. They also had take-home chemo bag systems that local hospitals can't offer. And the facilities are run incredibly well. The staff is highly attentive, the hospital makes smoothies for when mouth sores prevent eating (I couldn't eat for two weeks with mouth covered in sores), etc etc many other things. 5 years cancer free thanks to them and so incredibly grateful

[Photoshop]

You wouldn’t believe how many times I went real doctor after real doctor only to find the solution on some random YouTube video. Doctors can only do 2 things: give you drugs or do surgery. If you don’t want those two things you are on your own.

[CharisseBirdwell]

Sometimes these "top cancer centers" want to bill your insurance for every test they can think of and then tell you, we recommend that you return in 6-12 months for more testing.

[kkx]

ONC research manager for pharma for 10 years. Worked with all the big names along with a spectrum of investigative sites. I can say HANDS DOWN I would not send a family member to the big names unless they had something very rare. Operations at the big centers was on the edge before COVID and then the pandemic broke them. They are a total mess! Yes, they run a ton of trials and have KOLs but they are just not invested in actual patient care.

[JYAN]

My late brother (pancreatic cancer) went to Dana Farber for 2nd opinion with high hopes only to be told to follow his current chemotherapy treatment. They only recommended him to participate in clinical trials. He died from chemo side effects eventually within a few months. His cancer never grew. Died from malnutrition and cachexia not from the cancer.

[barbaraberwick]

Dr. Prasad, it would be extremely useful if you could talk about what questions a newly diagnosed patient should ask..I went to the original oncology appointments with one friend and now I am going with another. As a nurse, and as person who has listened to many of your talks I do know some things that I feel need to be asked. For instance, since my friend is 78 years old, otherwise in good health, we need to know what would be the "statistical average" of treatment vs no treatment in actual overall survival and in quality of life. However, I know that it is extremely hard for doctors to give that information because it is truly hard to know. However, there are probably ways of asking those types of questions that could help provide answers. Perhaps, you could make a video explaining the best type of questions to ask. Even if you don't, thank you for all you have done and continue to do

[Skandalos]

Trust breeds fraud and corruption. Distrust is my greatest tool.

[joannabusinessaccount]

The higher the academic titles, the busier these star doctors have to tend to writing grants, attending meetings, playing politics, dealing with finances etc. Translation: less time and soul with patients.

[mikaelamacnaughton]

Thank you for your important work! Thanks for having integrity! May you inspire many other great physicians to have the courage to

[Mjmsc]

My advice - and I get this from watching Vinay - and I’ve changed my practice to match - be able to reference actual studies when discussing complex or controversial treatments. If you tell a patient a guideline, know if it’s expert opinion or science based and be honest. Admit when you don’t know something. It gives you the biggest upper hand to getting good outcomes - patient trust and buy in.

[jannz]

We actually got THREE opinions because the first TWO opinions were conflicting. This was about our then 14yr old son needing a knee surgery. One opinion would have cut into his 'growth plate' and he hadn't finished growing. The second opinion pointed this out ... and the 3rd opinion confirmed the concern the 2nd opinion.

[casselfriemel]

Hi VP! I 100% agree...I always tell pts that a second opinion won't hurt my feelings, but just because the 2nd opinion doc @ Mayo/MDACC/etc recommends a certain treatment, there is always room for discussion -- we all trained at these centers and realize that these MDs are not gods, and many are not super intellectually gifted. The tertiary care center oncs also have little experience w/ community cancer care, and there are always many other tx paths other than the "expert recommendation".

[dianne.murielrobidoux]

Now wow! The vinay we want and appreciate ❤

[DaemonGeek]

Once again, Vinay, you provide a thoughtful and reasoned discussion on a medical topic which is helpful not only to the lay public, but to other practitioners as well. I always enjoy taking the time to watch your videos, and rarely do I consider that time not well spent. Kudos!