Can a member of the military, told he or she must have surgery, get a second opinion?
Military officials say yes. A Navy spokesman, for example, said, "the second opinion is highly encouraged in the military community."
I'm not sure it's always that easy. The answer may depend on where you are, what hospital, base or facility. Or whether you ask a cooperative doctor or an unsympathetic one. Or, one former military doctor maintains, who you are.
That may be unfair. Attitudes and policies have been changing in medicine, civilian and military. I'd like to hear from military members or dependents who have themselves tried to get a second opinion recently and succeeded or failed. (Just drop a note to me at The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Include your phone number.) Dr. John Beary, associate dean of medicine at Georgetown University, was an Air Force, then Naval Reserve doctor. From 1981 to 1983 he was deputy assistant secretary of defense for health affairs.
He is just a bit tentative -- he says it is hard to make flat statements about "some 12,000 physicians" -- but "in my opinion and experience second opinions are granted if asked for." He adds: "It may depend a lot on where you are." In an area like Washington, "there's a lot more opportunity" simply because there are so many military physicains in so many specialties, compared to the few doctors at many small facilities.
Even then, he says, military physicians can send a patient to a civilian specialist where no appropriate military consultant is available. When this is necessary, he says, "I've never heard of anyone being declined."
A more mixed view comes from a doctor who did not want to be named but has served at several Army bases: "It's like civilian medicine. There are always the guys who feel challenged and bristle and try to talk you out of it. That doesn't mean they may not be right sometimes. It depends on the problem."
A highly negative view is that of Dr. Lawrence Fink, a Washington area neurosurgeon and until 1980 a Naval Medical Center doctor with several temporary duty periods abroad. He says he keeps contact with medical friends in the military.
Whether you can get a second opinion, he says, "depends on who you are" -- if you don't have high rank, "you'll probably be dismissed out of hand or given some feeble excuse for an answer."
However, he said, "If you insist, it may be possible. You have to insist."
He said: "I have seen, with my own baby blues, patients threatened with discharge and sanctions for refusing to permit a procedure. Imagine an E2 or E3 Navy enlisted men being confronted by a four-striper captain ordering him to do this. It's not an equal contest."
The Navy spokesman said situations like that, if they occurred, are out of date.
"I haven't seen evidence of those kinds of pressures," Beary said. Still, he added, "I think it depends on the place and the people," and, just as in civilian medicine, "I think it depends to a large extent on how educated the consumer is."
In short, everyone should be aware that a second opinion is a medical right, that it is in a great many cases medically desirable and that a patient, military or civilian, must sometimes say, "I definitely want one."