【押さえておきたいポイントと注意点】セカンドオピニオンは受けるべきか？
セカンドオピニオンという言葉を聞いたことがありますか？近年、セカンドオピニオン外来を設けている病院も増えてきています。
この記事を読むことで、セカンドオピニオンはどんなものか、どのような場面で活用するべきかを知ることができます。
目次
セカンドオピニオンとは？
治療を受ける上で、患者本人が充分に理解、納得した上で、治療に励むことは、非常に重要です。
これまで、自身の病状や診断について、病院でなんらかの説明を受けた際に、「よくわからなかった」「納得がいかなかった」と言った経験をされたことがある方も、いるはずです。
セカンドオピニオンとは【セカンド】＝第二の＋【オピニオン】＝意見のことで、病気の治療や診断について、担当する医師の診断や説明以外に、意見を求めることを指します。
また担当する医師のことをファーストオピニオンとも呼びます。
セカンドオピニオンを患者に提供する医師の最も大切な役割は、診断や治療について、第三者的立場での専門的なアドバイスを患者に与えることです。
よく間違える方が多いようですが、病院を「転院」することは、セカンドオピニオンとはいいません。また次に挙げるケースは、セカンドオピニオンとしての対応ではありませんので、注意が必要です。
・治療費に関する相談
・医療訴訟目的の相談
・主治医の了承を得ずに、自ら他医療機関へ行き相談をすること
・医療事故（医療ミス）に関する相談
・生存していない患者に関して、家族が相談するなど
セカンドオピニオンはどのようなタイミングで活用するのか、受けるべきなのか？
では、セカンドオピニオンはどのようなタイミングで受け、活用するべきなのでしょうか。
あなたは、次のような場面に遭遇したことはありませんか？
・治療法をいくつか提示されたが、迷っている
・提示された以外の治療法がないのか、知りたい
・ 担当する医師から、診断や病気の治療方針について説明を受けたが、どのようにするべきなのか悩んでいる
これらは、いずれもセカンドオピニオンを受けても良いと考えられる状況であると言えます。一方で、セカンドオピニオンを検討する前に、押さえておくべき点があります。
・担当する医師の説明を充分に理解できているのか
⇒あなたの現在の状況を一番理解しているのは、現在あなたを担当する医師です。
担当する医師に、現時点で迷っていることは、最初に相談しておきましょう。
・医師以外にも相談できる窓口はないか
⇒病院には、医師以外にも看護師、医療ソーシャルワーカー、薬剤師、相談窓口、リハビリテーションスタッフ、管理栄養士など様々な専門家がいます。
場合によっては、医師より詳しい専門知識を提供できることもあります。
・自身が知りたいと思っていることは明確になっているか
⇒診断を受けた場合などは、不安が大きくなってしまい、本当に知りたいと思うこと、理解しておくべき情報を、整理できていないこともあります。
あなたが知りたいと思っていることが、明確になっているかを理解するためにも、一度、メモに書くなどして、整理することをおすすめします。
～セカンドオピニオンを受けたいと考えたAさん～
60代のAさんは市のがん検診で、乳がん疑いを指摘され、総合病院で精密検査を受けた。
その結果、左の乳房に3cmほどの乳がんがあり、手術が必要であることを、担当の医師より伝えられた。
医師からは、手術で、左乳房を全摘出することを提案される。
Aさんは一度、納得したものの、自宅に帰り、娘に状況を報告をした。
すると娘より、近年は乳房を温存する手術(*1)もあるようだと聞いた。
Aさんは、左の乳房を全摘出する以外の治療がないかを知りたくなった。
再度病院へ行き、その件を担当の医師に話すと、「他の治療法もあるにはあるが、全摘出が良い」と勧められた。
その上で、Aさんは、他の治療について知りたいと考え、セカンドオピニオンに踏み切ることにした。
⇒Aさんがセカンドオピニオンを受けるためのポイント
もしあなたがAさんの立場だったとして、セカンドオピニオンを受けたいと考えた際に、どのような点を不安に思うのでしょうか？
どこで相談したらよいのだろう、担当の医師は、快く紹介状を記載してくれるのだろうか、医師が怒ってしまうことはないか、といった点が挙げられるかもしれません。
セカンドオピニオンを受けようと決めた段階では、次のポイントを押さえましょう。
・担当の医師には、素直に気持ちを伝える
⇒患者は、治療や検査に関して、充分に理解ができるまで説明を受け、自分自身でどうするかを決定する権利があります。
そのことからも、セカンドオピニオンを受け、治療について自身で選択をすることも、患者の権利といえるはずです。
セカンドオピニオンを受けることを内緒にしたり、遠慮することで、担当の医師も患者の気持ちに気づけないことがあり、信頼が築きづらくなってしまう可能性があります
・セカンドオピニオンは、他の医師の意見を聞くこと
⇒セカンドオピニオンを受けることは、転院することとは異なり、今通院している医師のもとで、今後も治療を続ける前提で、他の医師の意見を聞くことです。
場合によっては、セカンドオピニオンを受けた病院で治療を続けたいと考えることもあるかもしれません。その場合は、セカンドオピニオンの結果を、元の病院の担当医師に伝え、改めて転院を申し出る必要があります。
まとめ
セカンドオピニオンとは、他の医師の意見を聞くことです。
現在通っている担当医師による、診断や治療法以外に意見が聞きたい等の場合に活用します。
治療費についての相談や医療ミスについてと言った内容の相談は、セカンドオピニオンには該当しません。
また、既に死亡されている患者のことについても、セカンドオピニオンとして相談することは、できません。
セカンドオピニオンを受けるためには、担当医師の意見を理解しているか、自身の知りたいと思っていることが明確になっているかを踏まえ、担当医師に対し、素直にセカンドオピニオンをうけたい旨を話しましょう。
（*1）乳がんの進行度合い（ステージ）にもよりますが、「乳房温存手術」は、乳房を部分的に切除し、がんを取り除く方法が存在します。一方で、乳房を全摘術する「乳房全切除術」は、大胸筋と小胸筋を残し、すべての乳房を切除する方法です。いずれも医師の判断に基づき提案されるものです。
参考サイト：独立行政法人 国立病院機構 大阪医療センター セカンドピニオン外来
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