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Your Guide to Getting a Second Opinion

When you receive a serious diagnosis or face an invasive procedure, you might wonder if you have all the information you need to make the best decision about your health. Is your diagnosis accurate? Have you been informed of every possible treatment option? Is that expensive test necessary? Is surgery the right approach?

These are the right questions. And when they come up, it’s often a good idea to consult more than one doctor.

“Whenever you’re not sure about your diagnosis or you’re considering a treatment that has some risk involved and is not urgent, you should look for a second opinion,” says Dr. Ilana Graetz, an assistant professor of preventive medicine at the University of Tennessee Health Science Center. “Don’t be shy about asking for a referral to another specialist. Your doctor should not be offended if they want you to get the best medical advice.”

Indeed, there’s no need to feel guilty about second-guessing your doctor’s verdict. For most physicians, being asked for a referral to get an independent opinion is nothing personal. That’s because many health conditions are difficult to diagnose accurately, and doctors sometimes disagree with one another about the best treatment approach. Moreover, misdiagnoses are common: One in 20 Americans seeking medical services experiences a diagnostic error each year, and most patients will experience at least one in their lifetime, according to a 2015 report by the federal Agency for Healthcare Research and Quality.

A score of studies have shown how second examinations can improve initial diagnoses. One published this month in the Annals of Surgical Oncology found that of 70 patients diagnosed with breast cancer who sought a second consultation, 43 percent received a modified diagnosis. A 2017 study published in the Journal of Evaluation in Clinical Practice compared referral diagnoses made by primary care physicians to final diagnoses from specialists for nearly 300 patients with a variety of conditions. The diagnoses only matched in 12 percent of cases. For 66 percent of cases, a second consultation led to a refined diagnosis. In 21 percent of cases, the final diagnoses were substantially different than the initial ones.

A patient’s right to ask around

Patients have a right to obtain copies of their medical records and test results. And many states include the right to a second opinion in their patient’s bill of rights, Graetz says. Thanks to electronic health records and patient portals, it’s easy to access your medical information and take it to another physician, she says.

Explainers

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But patients don’t always know about this right or feel inclined to use it. A 2010 Gallup survey found that 70 percent of Americans say they don’t feel the need to get a second opinion or even do additional research.

“You are more likely to look for a second opinion when you take your car to a mechanic than when it’s your heart,” says Ash Davé, president of Second Opinion Expert, an online service that provides specialist consultation on patients’ medical records. “The education is not there for patients. That’s the sad part.”

Who pays the bill

In most cases, additional care costs more money. “The opinion itself doesn’t really have cost associated with it, but the visit to that doctor absolutely does,” says Joe Hubbs, client operations manager at Sequoia One, which coordinates benefits programs for small companies.

But the initial expense may pay off in the long run by saving patients from getting the wrong treatment, says James Naessens, a policy and health services researcher at the Mayo Clinic who led the 2017 study.

Health plans vary in how they deal with second opinions. Some insurers, including Medicare, encourage patients to get second opinions for serious conditions; some even require them before green-lighting surgical procedures.

But some plans may not say anything specific about whether or not they cover second opinions. Moreover, each plan gives you different levels of freedom in terms of who you can see inside and outside of your network. Some insurance plans are designed with “narrow networks,” offering a limited number of specific providers that may not include many specialists for all diseases, Naessens says.

To find out how your health plan handles second opinions, and to what extent it covers them, you have to contact your insurer. Here are some questions to ask:

  • Are there specialists for your condition in your network?
  • Which medical services will be covered? For example, could you redo a biopsy or request a new pathology reading?
  • How long do you have to obtain a second opinion?

When you really need a second opinion

Don’t wait for a second opinion if you need immediate treatment for an emergency condition such as acute appendicitis, a blood clot or an aneurysm, or accidental injuries.

Second opinions are most important for conditions that are complicated and require invasive treatments. These include:

  • When you are diagnosed with a serious condition such as cancer
  • When the treatment itself comes with  risks, such as radiation therapy or surgery
  • When the suggested treatment is invasive, such as heart or back surgery or hip replacement. Some patients may benefit from less invasive approaches, such as lifestyle changes or physiotherapy.
  • When the treatment is experimental and not approved by the Food and Drug Administration
  • If you’re considering participating in a clinical trial

Getting opinions online

If you live in an area where you can’t find a specialist, or if your health plan doesn’t cover what you need, you can get a second opinion through several online services, where you upload your medical records for review by a physician specialist. In 8 out of 10 cases, the specialist doesn’t need to see the patient — medical records and test results suffice, Davé says.

These services come with a fee. The program at Dana-Farber Cancer Center in Boston, for example, costs about $2,000 per consult. A consultation and pathology review at the Cleveland Clinic’s MyConsult Online Services costs about $750, whereas Second Opinion Expert charges $600.

Fees for online services are often not covered by any insurance provider, including Medicare and Medicaid. However, some employers have contracted with such services and offer them as part of their health benefits packages, so make sure to check with your employer.

A second opinion checklist

  • Do not feel intimidated about asking your doctor for a referral. Tell them that you value and respect their opinion, but a second opinion would help you make decisions with peace of mind.
  • To choose your second doctor, ask around or consult the websites of disease-specific organizations for names of specialists. Most experts recommend avoiding your doctor’s colleagues because they might be less inclined to disagree with each other.
  • Check with your health insurance policy to avoid a surprise bill after getting a second opinion.
  • Schedule a visit with the second physician and make sure to have all your medical records sent to the physician’s office before your visit.
  • If the second doctor disagrees with your first doctor, you can ask if it’s possible for the two to discuss your case together. You can also seek a third opinion.

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The Paper Gown, a Zocdoc-powered blog, strives to tell stories that help patients feel informed, empowered and understood. Views and opinions expressed on The Paper Gown do not necessarily reflect those of Zocdoc, Inc. Learn more.