Introduction
Do You Need a Second opinion
Be careful out there.
There was a Johns Hopkins study that found that diagnosis errors contribute to about 795,000 deaths or permanent disabilities each year. That’s common enough that it could affect anyone at some point.
Mistakes happen and remain inevitable. Maybe that why they call it “the practice of medicine.”
Even when doctors agree on a diagnosis, they may not agree on what to do. One surgeon may recommend an operation, while another may suggest physical therapy. One oncologist may urge chemotherapy, while another may think that watching and waiting is the way to go.
That is just medicine. It is so nuanced! The plan is a result of the experience and training of the practitioner.
Why errors and disagreement happen
Visits today are rushed. We looked at that earlier. Specialists often see only fragments of a patient’s story Electronic records are filled with templated notes. I remember 40 years ago sitting in the morning watching my radiologist buddy reading xrays. He was dictating into a machine for a transcriptionist to type and return. This was in the days before computerized templates.
The first time I heard him say “type 1 chest” I had to ask what he was talking about. He had trained the typist in several different transcripts which were typed exactly the same. No individuality. That 3-word trigger saved him about 2 paragraphs of dictation.
The volumes of information are huge. When there is very limited time the odds of missing something is significant.
The statistics of evaluating second opinions is impressive. The diagnosis changes about 15% of the time. Mayo Clinic studied it and found that 88 percent of second opinions differed. Maybe it was refined and more specific but other times it was a different diagnosis.
When to slow down and seek a second opinion
Second opinions aren’t only for decisions with high risks. Trust your gut. If something doesn’t feel right, ask for another opinion. If the treatment feels rushed. Slow down the process.
If you’re being given a new diagnosis. Slow down. Get another opinion. Validate.
What especially should catch your attention? If surgery is recommended, get another opinion. If the treatment being discussed seems aggressive, just ask about the effect of trying something less dramatic, less severe.
Studies show wide variation in how often doctors recommend certain procedures. That variation should give you pause. How does the diagnosis lead to variations in recommendations from different doctors? Why would one doctor quickly recommend hysterectomy, and another doesn’t? The same might be true about the need for knee replacement, etc.
We talked about labs. Normal labs don’t indicate you’re healthy. It actually means your result is within the range that 90% occupy.
If the opinions conflict, it’s essential to go slow until there’s agreement. Two competent and capable doctors might see the same case differently. You should understand those differing opinions before moving on.
There are emergencies but very few conditions require decisions within hours or even days. Unless your symptoms are deteriorating rapidly or the diagnosis poses an immediate threat, it makes sense to take the time to clarify what your next step should be.
How to ask for a second opinion
Doctors are normal in that we deal with pride like most. You have to learn to ask without appearing ungrateful or disloyal. If your request is well-framed, it will rarely offend. Most doctors value engaged patients. It’s how you ask for a second opinion that sets the tone.
Requesting a second opinion is not challenging authority; it is just a wise precaution and good decision making, and that is usually well accepted.
Frame the request as confirmation. Most physicians appreciate knowing that you’re trying to strengthen the plan that is proposed.
Frame the request as if you are gaining clarity so that you have comfort proceeding. Keep the focus on the decision rather than the doctor. Your intent is not to cast doubt. You are seeking openness and transparency. You’re inviting steadiness and collaboration.
Many of us were taught not to question authority. Some doctors may hesitate when a patient asks for another opinion. Their reactions can be telling. If they get upset, that should be a concern for you.
When you go for a second opinion, showing up with your Health Journal makes the prospect for a good outcome more likely. After the visit, share what you learn. When handled transparently, a second opinion can deepen trust and strengthen, not strain, the doctor-patient relationship.
How to manage the process
Keep your primary care doctor in the loop. He’s the quarterback in the equation. You may be asking one specialist for a second opinion from another specialist, but you’d be surprised how your trusted primary care doctor can add clarity.
Check your insurance. Most insurers, including Medicare, cover second opinions on major diagnoses or surgeries. Some carriers require referrals, while others let you choose a doctor directly. If in doubt, call the member services number on your insurance card. You may be able to check through your member online portal.
This is where your Health Journal will shine. Your scans and labs tell one story; your experience tells another. A brief record of symptom onset and factors affecting them may show patterns doctors could overlook.
Many hospitals now offer online second opinion programs that pair patients with top specialists. Check to see if that is available in your hospital. Many times, those plans include department chairmen and even subspecialists. Many patients receive revised treatment plans.
Not every second opinion needs to come from another physician specialist. Physical therapists, nutritionists, or functional medicine doctors can clarify problems that resist a single diagnosis. Consider seeing someone with a different perspective like perhaps an acupuncturist.
Be prepared for the advice that may conflict. You’re not after more opinions, but a clear direction.
Pauses are usually good and may add a few weeks but seldom change an outcome. There are exceptions, such as aggressive cancers or fast-moving infections. Delay in these cases can mean you get worse in the interim. Ask the doctor to discuss any concerns they have about the added wait.
You also have to be practical. Delays can be costly in terms of time away from work and the other costs associated with the process.
Motion may feel like progress. Knowing when to stop is important.
With enough perspectives you’ll start to pick up patterns. When several trusted doctors see the same picture from different angles and come to similar conclusions it may be time to move on.
Stacking appointments and tests can increase your anxiety. If you are a worry wart, consider that. Anxiety could worsen symptoms. Sometimes an alarming result isn’t as ominous as it sounds.
The reverse can also be true: A normal result doesn’t always mean good news. If symptoms remain even though tests appear normal, keep looking.
Fibromyalgia and chronic fatigue often have normal tests. Yet, the symptoms persist. Many illnesses don’t have easy explanations. Many are complex. Your mindset can contribute.