‘Two heads are better than one.’ ‘Expertise matters.’ Both of these phrases ring true in the realm of medical second opinions. Whether you’re faced with a major new diagnosis, biopsy result, looming surgery or a cutting-edge cancer treatment, you want to move forward with as much peace of mind as possible.
When you see a doctor, second opinions can add certainty and confirm that you’re on the right course of care. Second opinions also sometimes bring up newer treatment options that may provide better outcomes. And most critically, second opinions can reveal a misdiagnosis or medical error that could have delayed vital treatments, led to unnecessary surgery or caused serious side effects from unwarranted medications.
Here’s when to seek out a second opinion, where to find highly expert sources and how this input can inform your important health care decisions.
[SEE: How to Describe Medical Symptoms to Your Doctor.]
Why Seek a Second Opinion?
When should patients get a second opinion? “Really, anytime they’re faced with a complex health issue or contemplating major surgery,” says Dr. Peter Rasmussen, a cerebrovascular surgeon and chief clinical officer for Virtual Second Opinions by Cleveland Clinic. “That could be something like concern about a cardiac valve, or a significant neurological disease or a cancer diagnosis.”
A seemingly simple diagnosis may still warrant a second opinion. “Even things that are so-called routine diagnoses like breast and prostate (cancer), which are very common — it’s not uncommon for there to be diagnostic errors and problems with recommendations that aren’t up to date or don’t conform to guidelines,” Rasmussen says.
Having the complete, correct information about your health situation is essential. Signs for when you should seek out another medical opinion include:
— You have recently received a life-changing or life-threatening diagnosis.
— You have a rare condition such as malignant mesothelioma, with only a few thousand U.S cases diagnosed each year.
— Your treatment program isn’t working or is giving you bad side effects.
— Major surgery with potential debilitating complications is recommended.
— You are diagnosed with cancer.
— You want a surgeon who has performed a specific surgery often, with good outcomes.
— You disagree with your diagnosis or treatment plan.
— You want to explore the most up-to-date, evidence-based treatment options.
— You have a symptom, like persistent headaches, that could be caused by a variety of physical or mental health conditions.
— You want to confirm that your diagnosis is correct.
— You’ve lost confidence in your physician or the communication between you two is poor.
— You receive two conflicting medical opinions, and you want a third opinion for clarification.
Second Opinions for Cancer
When the doctor-patient relationship just doesn’t feel right, that can be reason enough to reach out to another provider.
“There are two situations we think about — particularly in the cancer world but in other places too — where we think about second opinions,” says Dr. Arif Kamal, chief patient officer for the American Cancer Society. “One is really the level of comfort, trust and rapport a patient and caregiver have.”
This mutual trust leads to higher-quality treatment decisions and oftentimes, better outcomes, he says.
That goes beyond a physician’s specific expertise or where they received their medical training. “Certainly, there’s something to be said for that,” Kamal says. However, he adds, “If you’re just not clicking with a clinician you’re talking to, that’s an important signal that maybe you should seek a second opinion, as well. It’s not necessarily that the clinician is wrong. But you want to go in feeling confident that this person, for instance, has heard and understood what is important to you.”
Clinical trial access may be another reason to seek a second opinion from a doctor affiliated with a research study site. Specialists in the condition would be more attuned to research in the field.
“Patients and caregivers under-recognize that there may be clinical studies to answer the specific situation they’re in,” Kamal says. “Oftentimes, the next thing to do is something within a clinical study or trial.”
One thing to consider: “How unique or complex is my case?” Clinical trials may pertain to nuances of an individual case that standard treatments don’t necessarily address, he says.
Cancer innovation is exploding with targeted treatment options that focus on gene mutations in cancer cells or a patient’s genetic makeup. Over the last decade, Kamal says, cancer drugs have dominated new Food and Drug Administration approvals, both in terms of number and specific uses.
“That puts an enormous pressure on my colleagues in general oncology to keep up,” he says. With each drug, that includes awareness of changes in major indications for use, unique side effects, interactions with other drugs, possible black box warnings, logistics of intravenous infusions and more.
“It’s a lot of information you have to know as a generalist,” Kamal says. “And, so, for many patients with cancer, they feel that it’s more tailored care if they go to a person who specializes in that specific disease. For example, if you have pancreas cancer, you can go to a general oncologist. You can go to a gastrointestinal oncologist, who (focuses on the entire GI system). Or you can go to a person who mainly does pancreas cancer.”
Kamal says his preference would be to access a specialist who only does pancreatic cancer. “Oftentimes, they’re the ones who have access to the cutting-edge clinical trials,” he says. That includes access to brand-new drugs.
Treating cancer isn’t just about chemotherapy selection, Kamal notes. It’s also the procedural experience and expertise of the clinician, such as a surgeon or radiation oncologist.
“Surgery is the only way to really cure cancers,” Kamal says. “To be able to find it early and completely cut it out. Which means that the touch of that surgeon and their skills is very important. And we know, for example, for gynecological cancers like ovarian cancer, that gynecological oncologists — surgeons who specialize in resecting those types of cancers — have better outcomes, including survival, than, let’s say, a general surgeon.”
It’s up to the patient to decide whether to go to a specialist like a pancreatic cancer expert for a second opinion and treatment, Kamal says. “What’s non-negotiable, though, is that if you have cancer, you should seek the counsel of a cancer surgeon, specifically,” he says, adding that he would not recommend that someone with breast cancer go to a general surgeon in their community as opposed to a breast surgeon who does these procedures every day, all year long.
Remember that location can be a determining factor so you can seek a second opinion but if there is agreement, some patients prefer to get their treatment closer to home especially standard chemotherapy, immunotherapy or targeted drugs. Clinical trials can be the right answer especially if all standard of care treatments that are known to improve cure and survival have been tried.
[See: 16 Questions to Ask Your Oncologist at Your First Cancer Appointment.]
Second Opinions for Heart Problems
Heart valve malfunction is an example of a cardiology case that might benefit from a second opinion. “So, your local cardiologist believes you may need an aortic valve replacement,” Rasmussen says. “Of course, there are many options of how that can be done, through minimally invasive surgical options or open-heart surgery. There are different options of types of valves, maybe a mechanical or tissue valve.”
Beyond surgical details is the overriding question of whether the valve needs to be replaced at all, Rasmussen notes. “That’s a really good example of a patient who might benefit from a second opinion,” he says. “We’d put that patient’s case in front of our most senior valve experts, who’ve seen thousands and thousands of patients and generally are more comfortable in monitoring valve problems longer than most community cardiologists are — because they’ve got such vast expertise. So, it’s not uncommon that we don’t believe that the valve needs to be replaced at that moment and (instead) that patient can usually go a little bit longer with monitoring.”
Finding a Second Opinion
Your original doctor can refer you to a professional colleague who’s highly knowledgeable in your specific diagnosis and latest treatments.
Academic medical centers — university hospitals with medical training as part of their mission — are frequent sources of second opinions for an advanced level of expertise.
You can find top-rated medical centers with experts in specialty areas such as cardiology and heart surgery, neurology and colon cancer surgery through the U.S. News Best Hospitals rankings.
Disease-specific websites or online communities such as Patients Like Me can provide information on getting a second opinion for conditions including multiple sclerosis, fibromyalgia and Parkinson’s disease.
[READ: Where Do You Turn When You Want a Hospital Transfer?]
Virtual Second Opinions
Virtual second opinions from renowned medical institutions across the country are becoming increasingly available as facilities such as Massachusetts General Hospital, Cleveland Clinic, Yale Medicine, Duke Health, Mayo Clinic, UCSF Health and others begin to offer these services. Patients who want the benefit of that expertise can directly arrange to have their background information, medical reports, blood tests, scans and pathology results reviewed remotely.
Having a virtual second opinion is similar to the process for a patient going to an academic medical center in their area, Rasmussen says, except it doesn’t require any travel for the patient.
With Cleveland Clinic’s virtual service, “We make every effort to get all the medical records that the patient may have accumulated to that point in time,” Rasmussen says. “That includes the relevant medical imaging, and where appropriate, like cancer, the biopsy and surgical specimens for reinterpretation. We do all that work for the patient. They don’t have to be an expert in navigating the health care system to get those records. Then we give all those records to our experts in that area. Most of the time, there’s an adequate dataset that’s been accumulated for us to opine on what those patient’s concerns are.”
Patients typically pay for these expert virtual second opinions out of pocket, although some may be covered by the members’ commercial insurers who have relationships with the medical organization, Rasmussen says.
“We do offer solutions for patients direct to the consumer,” Rasmussen says. “We think we’re pretty competitive in the market relative to other academic health care centers who do this, or the commercial vendors of second opinions. Our current direct-to-consumer price is $1,850.”
What Can a Second Opinion Reveal?
Second opinions can uncover misdiagnoses, present other treatment options or just confirm original medical opinions. Here are types of things you might learn:
— A recommended surgery could be delayed rather than done immediately.
— Your original diagnosis can be corrected or refined to better pinpoint treatment options.
— Newer, targeted therapies are available for your individual type of cancer.
— The cancer you have is more (or less) extensive than originally thought.
— Alternative treatments with fewer side effects are appropriate for your condition.
— For any type of implant, you can find out more about various options, pros and cons.
— With a rare condition, a specialist can offer perspective and guidance on unique treatment options.
[See: 11 Pre-Surgery Tips to Boost Recovery.]
Misdiagnosis Potential
There’s research to support the value of second opinions:
— A second review by a multidisciplinary tumor board, performed at a National Cancer Institute-designated cancer center, resulted in a changed diagnosis — such as from invasive to noninvasive cancer — for 43% of patients with breast cancer in a small study published in the November 2018 issue of the Annals of Surgical Oncology.
— In about 300 patients referred by primary care providers to Mayo Clinic’s internal medicine division, 88% received a new or refined diagnosis, and 20% received a markedly different diagnosis in a study published in the April 2017 issue of the Journal of Evaluation in Clinic Practice. In contrast, 12% of participants had their original diagnosis confirmed as complete and correct.
— More recently, a study published in April 2021 in Mayo Clinic Proceedings concluded that getting a second opinion can reduce the rate of diagnostic errors by as much as 50%, and that a third opinion further decreases the diagnostic error rate.
First Doctors’ Attitudes on Second Opinions
As the patient, you shouldn’t hesitate or feel awkward about letting your original doctor know that you’re seeking a second opinion. Second opinions are common and health professionals often seek them themselves for cases that could use an added level of expertise.
With something that can be life-threatening like cancer, “The patient should be encouraged to seek a second opinion,” Kamal says. “If they bring up the concept of a second opinion to the original doctor they talk to, and they hear anything other than encouragement, then I would take that as a warning sign.”
When a patient of Kamal’s brings up a second opinion and asks what he thinks, “I support that,” he says. “At the end of the day, it’s about patient-centered care.” In addition, “peace of mind is super-important because that aspect of their care is what they can control,” he explains. “Cancer does so much to take control away from people. This ability to choose who’s on (their) care team is a sacred thing and we should honor it.”
Collaboration with shared knowledge is the best approach. For example, cancer patients may get a referral from their local physician to get a second opinion at a larger cancer center, Kamal says. There, they might undergo surgery but then the chemotherapy regimen could be managed locally.
“People do that all the time,” he says. “So there’s really a collaborative relationship between the first opinion and the second opinion — it’s not an adversarial one. That’s where patients do really well. There’s really peace of mind that more heads are being put together to think about their case.”
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When to Get a Second Opinion originally appeared on usnews.com
Update 05/04/22: This story was published at an earlier date and has been updated with new information.
