European Stars and Stripes (Newspaper) - July 23, 1991, Darmstadt, Hesse                                Patients seek opinion by Elisabeth Rosenthal the new York times who shall decide when doctors disagree a wondered Alexander Pope More than two centuries ago. Today the old quandary has taken on new urgency As difficult medical decisions once left to the doctor Are increasingly falling to the patient. Either because their insurance requires it or because they want another View of their options More and More patients Are seeking second opinions. At the same time dramatic developments in medical care give patients More and More choices that doctors Are increasingly ready to discuss. In the process patients Are discovering to their dismay that Medicine rarely offers Cut and dried answers. A patients Are clearly agonizing Quot said or. Robert Brook vice chairman of the department of Medicine at the University of California los Angeles medical Center. Quot if i go to one doctor and he says operate and another says done to whether i have the surgery or not i m going to be slightly uncomfortable with the  and Shari Doyle of Parlin n.j., kept a scoreboard of opinions when their daughter was born with a mild congenital deformity of her Skull. Some doctors voted for operating others said surgery would t help. The baby had successful a surgery late last year. Quot you go through such emotional turmoil hoping you re doing the right thing Quot said Laurence Doyle who made the decision to operate with the help of a Friend who is a neuroscientist. Quot i am frequently called to see patients in a state of panic because they can to decide what to do Quot said or. Alan 2.a. Manevitz a psychiatrist at new York hospitals Payne Whitney clinic. A in a poll of More than 1,000 new Yor City employees required to have a second opinion Belore surgery 12 percent complained that the second Mth opinion led to unnecessary anxiety. Still health care experts say that the process is worthwhile. Quot the confusion and anxiety is certainly better than having one opinion and not being confused when that opinion May be wrong for you Quot said or. Stephen Rosenberg director of new York City s employee benefits program who conducted the Survey. Brook is also convinced that the trend toward greater patient activism will be for the better although he acknowledges that the transition May be rough for patients and doctors alike. A your culture now expects answers and certainty from their doctors and patients Are going to have to get used to the idea that we Don t always know what works and what does to Quot he said doctors he added Are going to have to learn better ways to advise their patients about options without bullying them. Quot now too often it comes Down to a patient s asking a what do you think a and ill say lets do it making the decision for him Quot Brook said. For patients grappling with Tough medical decisions most second opinion programs will pay for a third opinion if a patient remains ambivalent or confused. Doctors Are developing interactive video programs to help patients understand the merits and limitations of various treatment options and to decide How they mesh with their values. People choosing Between surgery and drug treatments for bad backs for example May come to very different conclusions when they weigh the need for taking a drug for life against the risk of dying in surgery one video program helps men with enlarged prostates decide whether to have surgery. While swollen prostates can cause annoying urinary problems like the urge to urinate frequently corrective surgery often leaves men with abnormal sexual function. Quot we have found that men have very different priorities Quot said or Albert Mulley an internist at Massachusetts general Hospital who developed the program with colleagues at Dartmouth medical school. Quot for one 72-year-old, loss of sexual function May be a very big problem while for another it May not be an Issue. We want to help patients make a Choice based on an understanding of the Trade offs just the Way they buy an  Mulley and his collaborators or. John Wennberg and or. Michael Barry Are working on similar programs to help people decide about High blood pressure treatment Back surgery and whether to have a Mastectomy for breast cancer. Many insurance plans require that patients get second opinions before certain types of operations including hysterectomies hip and knee surgery Cataract extractions and Tonsillectomy is. Other patients Are seeking second opinions to Check on their doctors advice. Quot the conviction that the doctor knows Best a the Ben Casey Kildare sort of Trust a made it easier for patients but it probably was t very Good for care Quot said Manevitz. To confuse matters further the recent proliferation of new medical technologies has meant that today there Are More ways than Ever to treat a disease. Even a few years ago for example gallstones usually meant an operation in which the gallbladder was removed through a Large incision in the Abdomen. Today this traditional surgery is still an option but patients might also choose surgery through a Pencil thin fiber optic scope or treatment with drugs or with a device that uses sound Waves to pulverize the. Stones. Quot often there won t be a Clear Cut diagnosis or a Clear Cut next procedure and lots of people can t