If it hasn’t happened to you or to someone you love, it almost certainly will. At some point a physician will make a recommendation for a significant surgical procedure, or for a major treatment regimen to address an underlying health condition. As you or the person you care about begin to process the news, a series of big questions will come to mind: “Does my doctor have this right? How do I know I’m getting the proper recommendation? When do I decide if I need a second opinion?”
In this recent US News article, reporter Lisa Esposito takes a helpful in-depth look at this important and challenging issue. She explains why and when a second opinion is definitely a good idea, and she offers some tips and resources on how to pursue a second opinion. Whether you’re facing a major health issue or someone you love is in that quandary, Esposito’s report makes helpful reading.
The “Why” and “When” of Seeking a Second Opinion
To begin, Esposito gives us a handful of really good reasons behind asking for a second opinion when faced with a major diagnosis, surgery, or new therapy. She writes, “When you see a doctor, second opinions can add certainty and confirm that you’re on the right course of care. Second opinions also sometimes bring up newer treatment options that may provide better outcomes. And most critically, second opinions can reveal a misdiagnosis or medical error that could have delayed vital treatments, led to unnecessary surgery or caused serious side effects from unwarranted medications.”
According to Dr. Peter Rasmussen, surgeon and chief clinical officer at Cleveland Clinic, the more serious the diagnosis or procedure, the more imperative it is to get a second opinion. In his words, patients should seek a second opinion “anytime they’re faced with a complex health issue or contemplating major surgery. That could be something like concern about a cardiac valve, or a significant neurological disease or a cancer diagnosis.”
But even simpler procedures can benefit from another opinion. Rasmussen adds, “Even things that are so-called routine diagnoses like breast and prostate (cancer), which are very common – it’s not uncommon for there to be diagnostic errors and problems with recommendations that aren’t up to date or don’t conform to guidelines.”
Signs that Point to the Need for a Second Opinion
Esposito provides the following list of scenarios that may signal you to look for a second opinion. We thought that the list was worth repeating verbatim from her article:
- You have recently received a life-changing or life-threatening diagnosis.
- You have a rare condition such as malignant mesothelioma, with only a few thousand U.S cases diagnosed each year.
- Your treatment program isn’t working or is giving you bad side effects.
- Major surgery with potential debilitating complications is recommended.
- You are diagnosed with cancer.
- You want a surgeon who has performed a specific surgery often, with good outcomes.
- You disagree with your diagnosis or treatment plan.
- You want to explore the most up-to-date, evidence-based treatment options.
- You have a symptom, like persistent headaches, that could be caused by a variety of physical or mental health conditions.
- You want to confirm that your diagnosis is correct.
- You’ve lost confidence in your physician or the communication between you two is poor.
- You receive two conflicting medical opinions, and you want a third opinion for clarification.
What Can a Second Opinion Reveal?
In the article, Esposito goes into detail on seeking out second opinions in the specific cases of cancers and cardiovascular conditions. If you are interested, we highly recommend that you read the original article for more detailed information on those specific conditions.
But regardless of condition, second opinions can be incredibly revealing. They can uncover options to delay procedures, correct or refine treatments, or even reveal new/alternate therapies you hadn’t considered or didn’t know were possible. Esposito adds, “With a rare condition, a specialist can offer perspective and guidance on unique treatment options.”
And yes: second opinions can—and do—reveal misdiagnoses. Esposito writes, “In about 300 patients referred by primary care providers to Mayo Clinic’s internal medicine division, 88 percent received a new or refined diagnosis, and 20 percent received a markedly different diagnosis [according to] a study published in the April 2017 issue of the Journal of Evaluation in Clinic Practice. In contrast, 12 percent of participants had their original diagnosis confirmed as complete and correct.”
And even more recently, “a study published in April 2021 in Mayo Clinic Proceedings concluded that getting a second opinion can reduce the rate of diagnostic errors by as much as 50 percent, and that a third opinion further decreases the diagnostic error rate.”
Finding a Second Opinion
Second opinions can either be in-person or virtual. Esposito explains, “Your original doctor can refer you to a professional colleague who’s highly knowledgeable in your specific diagnosis and latest treatments. Academic medical centers – university hospitals with medical training as part of their mission – are frequent sources of second opinions for an advanced level of expertise.”
You can seek out medical centers with specific expertise through the U.S. News Best Hospitals rankings. Or you can check disease-specific websites and online communities such as Patients Like Me for recommendations based on your condition.
Online, virtual second opinions are both common and increasingly dependable. They’re available from renowned institutions like Massachusetts General Hospital, Cleveland Clinic, Yale Medicine, Duke Health, Mayo Clinic, UCSF Health and more. Esposito writes, “Patients who want the benefit of that expertise can directly arrange to have their background information, medical reports, blood tests, scans and pathology results reviewed remotely.”
Cleveland Clinic’s Dr. Rasmussen explains their online service this way: “We make every effort to get all the medical records that the patient may have accumulated to that point in time. That includes the relevant medical imaging, and where appropriate, like cancer, the biopsy and surgical specimens for reinterpretation. We do all that work for the patient. They don’t have to be an expert in navigating the health care system to get those records. Then we give all those records to our experts in that area. Most of the time, there’s an adequate dataset that’s been accumulated for us to opine on what those patient’s concerns are.”
How does payment work? Usually, virtual second opinions are paid for out of pocket, although it’s worth checking with your insurer just in case they have a partnership with the medical facility you’ve chosen.
First Doctors’ Attitudes on Second Opinions
The elephant in the room, of course, is that many of us feel awkward about seeking out a second opinion and offending our first doctor. But Esposito is quick to shut that down. “As the patient, you shouldn’t hesitate or feel awkward about letting your original doctor know that you’re seeking a second opinion,” she writes. “Second opinions are common and health professionals often seek them themselves for cases that could use an added level of expertise.”
This is especially true for anything life-threatening, like cancers or heart problems. And if your first doctor gives you anything less than encouragement when you bring up getting a second opinion, Esposito calls that a red flag.
Dr. Arif Jamal of the American Cancer Society is adamant that patients be supported by their first physician whenever they want to seek another opinion. “At the end of the day, it’s about patient-centered care,” he says, and adds, “Peace of mind is super-important because that aspect of their care is what they can control. Cancer does so much to take control away from people. This ability to choose who’s on (their) care team is a sacred thing and we should honor it.”
Kamal believes wholeheartedly that the first and second opinion should always be a collaborative relationship, not an adversarial one. There’s no room for conflict and jealousy in patient treatment. When doctors work together, Kamal says, “That’s where patients do really well. There’s really peace of mind that more heads are being put together to think about their case.”
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(originally reported at https://health.usnews.com)