Advice You Can Use
The Art of Getting a Second Medical Opinion
Know what to ask and when to ask for it
by Kimberly Rae Miller, AARP, December 9, 2019
Your physician enters the room with the results of your tests. He looks grim. Your symptoms indicate that you have something serious; he wants to start treatment immediately — there's no time to waste. You're in a state of shock. Your survival instincts shout: Just do what the doctor says!
Now, consider a different scenario. Your physician enters, and she's grinning. Tests are negative. Those symptoms that worried you so don't appear to be problematic. Take a couple of ibuprofen and come back in six months. You're relieved. But still, something doesn't seem right.
In either situation, your next move should be the same: Seek out a second opinion.
Consider this: A 2015 study found that seeking a second opinion led to changes in the course of treatment for approximately 37 percent of patients and changes in diagnosis for 15 percent. If there's a better than 1 in 3 chance that your doctor's first instinct isn't necessarily the best way forward, don't you owe it to yourself to examine all your options for treatment?
"Getting a second opinion is good medical practice,” notes R. Ruth Linden, president of Tree of Life Health Advocates in San Francisco, which helps patients navigate the health care system. “Medical knowledge is always changing; newer treatments are always in the pipeline. Clinical trials and other kinds of investigational procedures or therapies might be available."
Boost your knowledge about your condition, advises oncologist Adil Akhtar, by finding out the following:
What is my diagnosis?
What more can you tell me about the disease?
What is the status of my disease?
Is my disease treatable or curable?
What is my prognosis?
What is the goal of treatment?
What are my treatment options?
Do you agree with the treatment plan recommended by my previous doctor?
Where should I get my treatment and why?
Do you know of any clinical trials for my condition?
How can I manage the disease's symptoms during and after treatment so I maintain my quality of life?
Here are the answers to many common questions about getting second opinions.
When should I seek one?
Do this any time you've been given a diagnosis that could have serious implications, says Sue Varma, a psychiatrist and clinical assistant professor of psychiatry at NYU Langone Health. Examples include being prescribed medication that has serious side effects; surgery; a life-changing diagnosis; or costly procedures that aren't covered by your insurance.
And sometimes you should seek additional medical consultations if you aren't being diagnosed at all, Linden adds: “If a physician is dismissive and not curious about understanding what's going on for a patient, and not willing to do a full workup and dig deeper, that's when it's time to seek a second opinion.” If you feel like your symptoms are being trivialized, or your doctor couldn't find anything but something is clearly going on, consult another physician.
Am I putting my relationship with my current doctor at risk?
Rest assured that getting second opinions is a simple, routine part of medicine. In fact, your physician may also be seeking one or more additional opinions. “Doctors ask their colleagues for curbside consults all the time,” Varma explains. “Sometimes a fresh pair of eyes and a new perspective help if you've had a long-standing relationship with a patient."
It's not uncommon, however, for patients to forgo a second opinion for fear of insulting their physician. Set that notion aside. You are in charge of your health; one particular doctor is not. “Many patients think that seeking a second opinion somehow indicates a lack of trust, rather than a desire to confirm what their doctor has told them and explore options their doctor either might not have access to or be aware of,” Linden observes.
How do I make it happen?
There are two paths forward — one with help from your physician, the other without. (Remember: You don't need your doctor's permission to seek a second opinion.) For some patients it's important to go into a secondary consult with a blank slate. If you'd be more comfortable seeing a physician independent of your diagnosing doctor, Linden suggests connecting with others who have received the same diagnosis and asking about their experience. Activist groups, organizations and support societies are all sources for feedback and names of specialists.
But it may be easier for you just to ask your physician for a referral. And enlisting your original doctor in the process will make it simpler to transfer records and test results to your new provider. If you're concerned that the first doctor's opinion might influence the second's, don't be. Physicians receiving patients for a second opinion understand that their job is to reexamine and reevaluate the information independently.
"I consider myself to be an advocate for my patients. I always encourage a second opinion, and I may be able to help them find an expert for their disease and get the appointment as soon as possible,” says Adil Akhtar, an associate professor of medical oncology and hematology at Oakland University William Beaumont School of Medicine in Rochester, Michigan. That's the attitude you want to see in your doctor.
Who pays for it?
The vast majority of insurance programs, including Medicare, do cover second opinions. But the golden rule is to speak with your insurance provider first. For the most part, it will be a matter of finding out the proper protocol to follow within your provider's guidelines. PPO plans provide the most straightforward course of coverage, while managed care and HMO plans may require prior authorization and/or the use of a plan-approved provider.
How do I prepare?
Gather copies of your medical records or have them sent directly to your second-opinion physician. Although it may be tempting to start testing from scratch, any duplication may not be an option, depending on your insurance. Research your diagnosis, know what tests are customary, and be prepared to ask questions (see “Information, Please!” at left).
What do I do if the two diagnoses are significantly different?
If a second opinion has created more questions than answers, you can absolutely pursue a third or fourth medical opinion. Varma says she sought out numerous doctors when her mother, who had a cardiac condition, was also diagnosed with breast cancer. “We needed someone who was comfortable treating the cancer in a way that wouldn't impact my mother's heart,” Varma notes.
"Patients often have better outcomes when they go into treatment with confidence rather than half-heartedly or with worry. So there is value in those opinions, even if they don't shed new light on the treatment,” Linden offers.
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