This article originally appeared in the magazine New Choices and won the 1997 National Health Information Gold Award, developed as a seal of quality by the Health Information Resource Center. According to the Mayo Clinic, whose health newsletter won the award in 2000, the organization is a national clearinghouse for consumer health information whose annual awards program is the largest of its kind.

The major reason that opinions differ so much is that doctors do. Even for conditions for which there’s much less disagreement than there is for prostate cancer, you could see three different doctors and easily walk away with three different points of view. Here are some of the ways that doctors differ:

• Philosophy of Practice: Some doctors are very aggressive in applying therapies that might help but which also entail risk. Other doctors worry more about the potential side effects of highly invasive treatments, like radical prostate surgery, particularly when the evidence of their effectiveness is weak. In general, surgeons are more aggressive than non-surgeons, but even surgeons vary in their approach.
• Specialty: If you think about it, it makes sense that surgeons would be more aggressive. They chose to go into that specialty instead of, say, cardiology because they like to operate. It stands to reason that if you consult a surgeon, you are likely to end up with a recommendation to operate. Doctors are also more likely to recommend an option that they have more experience with.
• Knowledge: Some doctors simply know more than others. Look for one who is board-certified (You can find out by calling the American Board of Medical Specialists at 1-800-776-CERT). Such factors as where the doctor trained and whether the doctor has an appointment to a local medical school also tend to reflect knowledge. One area that deserves special mention is whether the doctor has stayed current with scientific advances. Medical information is expanding at a rate that no doctor can keep up with completely. Some, however, do a much better job than others. A doctor may not recommend an approach simply because he or she hasn’t heard of it.
• How They Are Paid: We’d like to think that money would have no effect on what a doctor recommends, but sadly that’s not true. This isn’t to say that all doctors are greedy business people, but money has a subtle way of coloring a doctor’s judgment. Keep in mind that a surgeon recommending an operation, for example, may stand to make thousands of dollars if you have it. 

One of the main problems in sorting out differing opinions regarding the best treatment is that we often don’t have enough good scientific data to say which approach is best. In the case of prostate cancer, good studies are now under way, but the results won’t be available for another decade. In the meantime, treatment decisions will have to be made using the best information available. 

Keep in mind, too, that just because doctors disagree doesn’t mean one of them is wrong. There are reasonable differences of opinion, and often more than one approach will work. On the other hand, just because doctors agree doesn’t mean they’re right either (or that what they recommend is right for you). In the 1960s, most surgeons would have agreed that routine tonsillectomies were a good idea. We now know better. 

When your doctors are giving you conflicting advice, try following the general strategies listed below to figure out the best course of action: 

1. Learn as much as you can about your diagnosis and the recommended treatments. The more you know, the smarter questions you’ll be able to ask, the better you’ll be able to evaluate what a doctor says, and the more you’ll be able to tell if that doctor is up-to-date. Resources include books, magazine articles, on-line services, and consumer groups. 
2. Don’t feel pressured to decide right away. At times, you may not have a choice, but in most non-emergency situations, the delay of a couple of weeks in making a decision is not critical. Some people go along with treatments or tests they really don’t want because they sense their physician favors it. It can be beneficial to get out of the glare of the doctor’s office to make your decision. My recommendation is to collect yourself, do a little reading, talk things over with your family and loved ones, and make your decision. If what you decide goes against the doctor’s advice, you may want to bring a supportive family member along with you on your return appointment, so that you don’t end up agreeing to something you don’t want.
3. Ask the doctors why they feel the way they do. If you can understand the rationale for each doctor’s recommendation – and not just the recommendation itself – you’ll be in a much better position to evaluate it. By getting below the surface, you can gain insight into the doctor’s philosophy of practice. Is there scientific data behind the advice or is it based on personal experience? What would happen to you if you didn’t do what is recommended? Would a delay be harmful? 
4. Ask each doctor to critically evaluate the differing opinions of his or her colleagues. One doctor may spot weaknesses in another’s reasoning that might not have occurred to you. Physicians may also differ in their assessment of the value of a particular treatment. Try to get each one to write down his or her thinking and show it to the others. Doctors may be able to explain things in a language a colleague will understand better than you can.
5. Examine the financial incentives. In sorting out a doctor’s recommendations, it pays to know where the financial incentives lie. With traditional insurance, the more a doctor does, the more the money flows. This reimbursement system was in part responsible for the millions of unnecessary operations, such as hysterectomies and tonsillectomies, that were done in the last several decades in this country. It stands to reason (and studies confirm) that when a doctor stands to profit by recommending a test or treatment, he or she is more likely to do so. These days, Health Maintenance Organizations (HMOs) and other managed care plans encourage doctors to keep costs down. In fact, under managed care, a physician’s income is often directly proportional to how little he or she does. Bonus plans reward doctors who order fewer expensive services, like mental health care or hospitalizations. Under some so-called capitation plans (literally by the head), physicians receive a flat monthly fee per patient; the cost of every MRI scan, referral to a specialist, or day in the hospital comes directly out of the doctor’s check. The result is that doctors in managed care may be more likely to advise against costly interventions that might benefit you. 
6. Get a third opinion. In obtaining a third opinion, it’s usually a good idea to consult a doctor unaffiliated with either of the other doctors. It’s also sometimes beneficial to consult a doctor in another specialty. For example, if heart surgery is recommended by a cardiovascular surgeon, consider consulting a cardiologist, a non-surgeon who also specializes in the heart. Given the financial incentives in HMOs against providing expensive services, it is often a good idea (if you can afford it) to get an opinion from a doctor outside of the plan. Under some HMO contracts, doctors are forbidden to advise you of medically viable alternative treatments that the plan doesn’t want to pay for. Doctors who violate these so-called “gag rules” risk being thrown out of the HMO. If you fear you may not be getting the whole story, the best solution may be to see a doctor who can speak unfettered.
7. Go with your gut. Ultimately, many medical questions have no right answers. Decisions often must be made on incomplete information. Get as much data as you can, talk with your friends and family, but, in the end, you’ll have to do what feels best to you. Remember that many medical choices hinge more on value judgments than on science. Is a shot at living longer worth it if it means you’d have to live with serious side effects of treatment? The answer is not strictly medical. It depends on what’s more important to you: the length of your life, or its quality. 

Since you are the one who will have to deal with the consequences of any medical treatment, it ought to be your values – not your doctors – that determine what is done. Of interest, this assertion has been validated scientifically.