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Getting another doctor's view can dramatically change a treatment plan — or even a diagnosis.
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updated 2/4/2008 8:48:38 AM ET 2008-02-04T13:48:38

In 2004, I almost agreed to a risky and complicated surgery for my 7-year-old son, who had chronic sinusitis. The local ear, nose, and throat doctor said it was best, but my husband and I couldn't shake the feeling that there had to be another treatment that didn't include the chance of brain damage and blindness. So we sought out the head of otolaryngology at a nearby university-affiliated medical center.

Turns out our second thoughts — and that second opinion — were the best thing that could have happened for Benny, who wound up with a far less dangerous treatment plan that involved removing only his adenoids. He bounced back fast from the surgery, and 3 years later, he's had only one sinus infection requiring antibiotics.

As we discovered, getting another doctor's view can dramatically change a treatment plan and even a diagnosis — research finds it happens in as many as 30% of cases. In one particularly dramatic finding recently published in the journal Cancer, the recommendations for surgery changed for more than half of breast cancer patients who received a second opinion. In some cases, previously undiagnosed second tumors were discovered. Still, almost 50% of Americans never get second opinions, according to a 2005 Gallup poll. But it's key to getting the best diagnosis and treatment, says James Rohack, MD, a trustee with the American Medical Association and a cardiologist in Temple, TX. "You may even prevent an unnecessary procedure or the cost and side effects of medication you might not need."

Now you can get an elite doctor to weigh in as well: Top medical centers such as the Cleveland Clinic and Partners' Center for Connected Health (which is affiliated with Harvard Medical School) offer second-opinion services via the Internet. This practice of consulting from afar using patients' medical records and test results is having a profound effect on how problems are treated. According to Partners, although its experts changed only 5% of diagnoses during its first year of providing e-consults, 90% of the treatment recommendations differed from the referring physician's plan.

Even if you don't take the second doctor's opinion, simply knowing your options and thinking through the pros and cons can improve your care. You don't have to have a serious condition to benefit. "There may also be more than one way to approach the same problem, or there may even be a financial incentive for a physician to recommend one treatment over another," says Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, an online patient advocacy practice. "Also, doctors can diagnose any problem incorrectly."

Here's a simple plan to get a full perspective on the best way to treat your health concerns.

When you must get a second opinion
Your doctor suggests surgery. You should always question elective (planned, nonemergency) procedures, especially if a less-invasive alternative is available. (Insurance, including Medicare, frequently requires second opinions in these cases.)

She prescribes long-term use of medications with side effects. Ask about non-drug-related options — especially if your physician is prescribing medication to prevent a disease, a growing practice. Called primary prevention, this approach means that if you have borderline high cholesterol but a family history of heart disease, you may be prescribed a cholesterol-lowering drug for your lifetime. Another physician might simply advise you to exercise regularly, stick to a low-fat diet, and check your cholesterol more frequently.

You're not getting better. For something like a rash that won't go away, it's always best to see your general practitioner first. If you're still scratching 2 weeks later after trying several treatments, ask him for a referral to a dermatologist rather than seeking out a specialist yourself, suggests Kate Clay, RN, program director at the Center for Shared Decision Making at the Dartmouth-Hitchcock Medical Center in Lebanon, NH. "Keeping doctors in the loop allows them to know what's working and what's not. That's how they learn to practice good medicine." And that ultimately improves your care.

How to get the best advice
Provide your tests results and medical records. You may feel you'll get a fresher perspective if the second physician isn't aware of your first physician's opinion, but most experts don't think "blind" second opinions are a good idea. "It's harder to render a second opinion without knowing the basis of the first doctor's opinion," says Jonathan Schaffer, MD, an orthopedic surgeon and managing director of My Consult, the Cleveland Clinic's online medical second-opinion service.

Consider online second opinions — with caution. For starters, they don't involve face-to-face contact with a physician but rather a written diagnosis and recommended treatment plan. In some cases, if you have questions, you can speak by phone with a nurse assigned to your case — but not necessarily the doctor who evaluated your tests. Another drawback: Online second opinions — which range in price from $225 to about $750 — aren't always covered by insurance. The upside is that you receive the expertise of a top specialist without having to travel or take time off from work, which can ultimately be cost-efficient.

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Be smart about conflicting advice. Your second doctor may contradict the first. If this happens, you can talk more with your first doctor about the differences or go to a third doctor — though be aware that your insurance might not pay for this. Another option: Log on to decisionaid.ohri.ca/decguide.html and access the worksheet used at Center for Shared Decision Making to counsel patients. Ultimately, in making these types of decisions, the thing to consider foremost is what you're trying to achieve, says Clay. "In life-and-death situations, some people want to live longer and some want to live better. It's quantity versus quality, and that's a very personal decision." In less serious cases, it can be a matter of weighing your current discomfort level against the risks involved with the available treatment options. The best choice, says Clay, "is the one that helps you reach more of your goals while allowing you to accept living with the good and bad consequences."

Find Dr. Right
When you need a second opinion, here's what you'll want to look for:

A doctor affiliated with a hospital other than your original one. Hospitals and practices can be set in their ways when it comes to treatments, says Gazelle. For example, some use tests even when there's insufficient research behind their efficacy simply because staff members have developed them. You want to be sure the recommended procedure is what's best for your unique medical situation.

A staff member at a big research and teaching hospital. This is especially important if your condition is rare (say, an unusual form of cancer) or complicated — for instance, you suffer from heart disease and have also been diagnosed with asthma. "These places attract physicians interested in learning new procedures and remaining on the cutting edge," says Rohack. Another advantage: Such centers will have a variety of specialists on staff who can contribute their expertise to your case.

A physician who's more experienced with your problem than the first doctor. This is the minimum you should do if your condition is more common — you've recently been diagnosed with diabetes or might need a hysterectomy. Ideally that means a board-certified specialist in the area of concern. To check on a doctor, log on to the American Board of Medical Specialties at abms.org, or call (866) 275-2267.

Get your first doctor on board
Telling your doctor you want to see someone else for a second opinion can be awkward, particularly if you've known him for years. But a good doctor won't be insulted and many will recommend it to you themselves, says Kate Clay, RN, program director at the Center for Shared Decision Making at the Dartmouth-Hitchcock Medical Center in Lebanon, NH. If they don't, here's what she suggests you say (or don't say) to your doc:

Say: "This is a difficult decision for me and I'd like to learn about other treatments than the one we discussed. Can you recommend someone I could talk to?"

Don't say: Any version of "I don't trust your judgment. I don't like you. I'm not sure if you're a good doctor." Comments like these would put anyone on the defensive.

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