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Want a Second Opinion? When to get one and what to expect

In Canada, only patients who request a second opinion will go through the process of getting one. So how do you know when to make the request? When a diagnosis is particularly serious or if your condition calls for aggressive treatment or surgery, it may be time to consider a second opinion. Second opinions are a normal part of the health care process; your family doctor or specialist (whoever provided the first diagnosis) should have no problem helping you seek one out. More importantly, it is your right to ask for one! Although you may feel uncomfortable or unsure about how to bring it up, you deserve the opinion of another health professional if you’ve just been diagnosed with something serious. Take the leap—and ask! Speaking up means potentially finding better treatment options (or even receiving a different diagnosis).

Consider why you want a second opinion
Talk to your doctor
Make the request
What to expect
What happens next?

Consider why you want a second opinion

You know yourself best. If you feel that the opinion of another physician could impact your health in a positive way, you should let your doctor know. There is simply no way that any one doctor can remain up to date on all of the newest medical research; and another doctor may be familiar with a treatment that your current doctor hasn’t yet heard about. A fresh perspective never hurts! A new doctor may notice something that was missed during the initial assessment.

Evaluate why you want a second opinion, and go from there. Below are some good reasons to get a second opinion:

• You feel nervous or are uncomfortable with the treatment plan; for instance, you have been prescribed drugs you are reluctant to take or are scheduled for a major surgery that poses risks you are hesitant about
• Your doctor is unable to diagnose your problem, or you disagree with the diagnosis
• You have noted no improvement in your medical condition
• You have been diagnosed with a life-threatening disease such as cancer, heart disease, or a brain tumour

If any of the above describes your situation, you should definitely consider a second opinion. Remember though, the purpose of getting a second opinion is not to generate a "better" health outcome, but instead to receive an alternate medical evaluation. You could receive a diagnosis that is more serious or a treatment plan that carries greater health risks. What you will have in the end is your options, providing you with the information necessary to make an informed decision about your health.

Talk to your doctor

Before asking for a second opinion, it’s a good idea to make sure that you and your doctor are on the same page. Talking with your doctor (requires Adobe Reader) means ensuring you have the necessary facts about your care. Getting the answers to your questions will help you feel confident that there have been no miscommunications along the way, and may help you understand how he reached his conclusion. Communicating openly with your doctor may result in you pursuing the health options he suggested initially. Or, having more information will simply help you decide if a second opinion is right for you.

After a diagnosis, you may want to ask your doctor these questions:

• Why this diagnosis and not another?
• Did you exclude any other diagnoses, and why?
• Are the tests you used to arrive at my diagnosis prone to false positives?
• Using my test results and any applicable diagrams, can you show me how you arrived at my diagnosis?

For treatment concerns, try asking the following:

• Why this treatment and not another?
• Are there any other options?
• Did you exclude any other treatment options, and why?
• What are the risks associated with each treatment?
• What are the benefits of each?
• How will each option affect my quality of life?

If you are leaning towards a second opinion, explain to your doctor that you understand his diagnosis and/or treatment recommendations, but that you still have concerns. Most doctors will understand and will not have a problem referring you to another physician.

Make the request

When it comes to a new diagnosis or treatment, don’t feel that you are being disloyal to your doctor if you decide to ask for a second opinion. However, if you feel uncomfortable initiating this conversation with your family doctor, another option is to visit another doctor on your own. If you live in an area with many health facilities nearby, it may be possible to see another doctor just by calling the office. Remember, unless your family doctor arranged the appointment, your medical records won’t be accessible to the new doctor; it will be up to you to provide a copy.

Alternatively, you can visit a clinic or urgent care centre. A doctor in this setting will not have time to review your health record, and will be making a diagnosis based only on your present symptoms and any information you can give him. Be careful about considering his diagnosis over the original one—especially if the original diagnosis came from a doctor who knows your medical history.

If you have already seen a specialist and wish to see another one, you can always go back to your family doctor to make the request. And even though you may feel uncomfortable doing so, you can also ask your current specialist for a referral to a different one. Read more about finding a specialist on this website.

If you have access to a reputable private second opinion service, you can request a review of your medical records by a team of highly qualified specialists from well-respected health care institutions. You will be asked to sign an agreement allowing the provider of this service to access and gather your medical records. Once your file has been received by the medical team, the review is usually completed within a few days. Learn more about second opinions available through this service.

What to expect

If you get a second opinion, expect the new doctor to request all of your relevant medical records. It's always a good idea to keep an up-to-date copy on hand. If you are waiting for your records to be sent from one office to the next, having copies of your own to share with the doctor can help the process along. Once the new doctor has all of your relevant medical information, he can evaluate what has been done and then order additional tests if needed; or he may base his opinion on tests that have been performed already.

A second opinion usually results in one of the following scenarios:

1. Agreement with the initial diagnosis and/or treatment plan
2. Agreement with the initial diagnosis; alternate or additional next steps are still recommended
3. Divergence of opinion; different diagnosis and alternative next steps are recommended

What happens next?

If you have been seen by two doctors, and both of them have reached the same conclusion, you can decide which of the two you would prefer to oversee your treatment. Typically, you cannot receive treatment from two physicians who specialize in the same field of medicine.

If different and/or additional next steps are recommended, you can choose to accept or reject these recommendations. If you decide to go ahead with the new treatment plan, the second doctor will be your treating physician. If you prefer the recommendations of the first doctor you saw, schedule an appointment with him and explain that you have decided to go with his recommendations.

If the second doctor disagrees with your first doctor’s diagnosis or treatment plan, it is up to you whether or not you will accept or reject his conclusion. If you accept his diagnosis or treatment plan and want to follow his recommendations, this doctor will now be your treating physician. However, you can always decide to go back to the first doctor you saw if that is your preference. The final decision is always yours!

Getting a second opinion can be a lengthy process; but oftentimes, it can be well worth the time and effort. The process will require patience, perseverance, and an understanding that it may not result in a different (or better) outcome. But in the end, no matter what the results, you will feel better knowing you’ve done everything in your power to fight for your health.

Key Websites:

• HealthLinkBC: Understanding lab test results
• Ontario Council of Agencies Serving Immigrants: What are my rights as a patient?
• Ontario Hospital Association: Your health care – be involved (requires Adobe Reader)

Related Articles:

• 8 Helpful Hints for Finding a Doctor Faster
• Specialists: Getting referred and getting seen fast
• Accessing Your Medical Records
• Your Personal Health Record (PHR)

References