How to Choose a Doctor

When to get a second (or third) opinion

Unfortunately, doctors, even your own trusted physician, can miss a diagnosis, especially nowadays, when they may be under pressure to see many patients in a short time. Studies indicate that more than 20 percent of patients in emergency rooms or intensive-care units are diagnosed incorrectly, and the problem undoubtedly extends to doctors' offices, too.

So it pays to research any diagnosis you receive to learn what questions to ask, whether you need additional tests, and when to seek a second opinion. Obese individuals diagnosed with asthma, for example, should ask whether their breathing problems might actually stem from their excess weight. Here are several other situations, nearly all of them common, where you may need to consider a possibly overlooked problem.


Surgery or Second Opinion?

In general, avoid surgery unless the problem threatens your health or disrupts your activities, less aggressive treatments have failed, other causes have been ruled out, tests show that surgery would help, and there's little hope of spontaneous recovery. And get a second opinion if you have the slightest doubt about whether you need the procedure.


HIDDEN BREAKS

Many serious sports injuries--including ruptured Achilles tendons, torn rotator cuffs, and even broken bones--are dismissed as sprains or strains.

• Wrist injuries. An apparently sprained wrist caused by falling on an outstretched hand can disguise a fracture of the scaphoid bone, just below the thumb. The break may not be visible on X-rays for several days. A scaphoid fracture that's not treated promptly may never heal properly.

What to do: A painful wrist injury after a fall should be considered a possible scaphoid fracture. The wrist should be placed in a cast, especially if there's deep aching on the thumb side of the wrist, pain where the base of the thumb bone meets the wrist, swelling, or difficulty holding objects.

• Ankle sprains can also hide a fracture that may not show up on standard X-rays. Physicians who focus on treating the sprain often miss this break, called a Jones fracture.

What to do: Make sure the doctor manipulates the outside edge of your foot, midway between the protruding anklebone and the base of the little toe. Severe pain there signals a Jones fracture.


MISTAKES IN MEN

Men and their doctors may overlook certain serious conditions because they either don't know that the symptoms are different in males or don't remember to check for a problem that occurs mainly in women.

• Anger problems. Men often turn their depression outward, lashing out at others. Even when they recognize depression, they're more likely to try handling it on their own, often by "self-medicating" with alcohol or drugs. Doctors may also miss those unconventional signs and symptoms.

What to do: Men who often feel angry should ask their doctor about possible depression. If necessary, family members should encourage the man to get help.

• Lumps. Men may delay seeking evaluation for a lump under the nipple because they think men don't get breast cancer. Or they may delay because they've heard about gynecomastia, a benign growth of breast tissue, which eventually affects about one-third of all males. Gynecomastia is sometimes caused by the use of marijuana or medications, such as digoxin (Lanoxin) or H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac).

What to do: Men who develop such a lump, especially on one side only, should see their doctor, who may order a mammogram or biopsy.


MISDIAGNOSED WOMEN

Women are often diagnosed incorrectly, too, in some cases because the condition is considered a normal female problem.

• Menstrual problems. Excessive and prolonged menstrual bleeding may indicate von Willebrand's disease, the most common hereditary bleeding disorder in the U.S. The disease is misdiagnosed more often in women because the main symptom, heavy and lengthy menstrual bleeding, is often mistakenly considered a gynecologic rather than a hematologic problem.

What to do: Women who have copious menstrual bleeding and also bruise easily or bleed readily or excessively in other situations should consider seeing a hematologist, or blood specialist.

• Bloating. Many people diagnosed with irritable bowel syndrome--a predominantly female disorder featuring intermittent abdominal pain or bloating plus altered bowel habits--actually have celiac disease. That's an allergy to gluten in wheat, rye, and barley that may have serious consequences, such as anemia or osteoporosis.

What to do: If you are diagnosed with irritable bowel syndrome, ask your physician about being tested for celiac disease.