Seeking a second opinion: When, why, and how?

Maybe you're wondering if the heart procedure your doctor has recommended is really necessary. Or perhaps you're experiencing persistent heart-related symptoms despite treatment, but your physician has told you "There's nothing more we can do."

These scenarios are examples that often prompt people to seek a second opinion — an option that may be increasingly appropriate as new treatments for heart disease become more widely available and more specialized.

"In recent years, minimally invasive procedures for treating structural heart problems have become widespread," says cardiologist Dr. Dale Adler, executive vice chair of the Department of Medicine at Harvard-affiliated Brigham and Women's Hospital. Problems such as a leaky or narrowed heart valve (which once required open-heart surgery) can be addressed using a catheter that's inserted through a tiny incision in the upper thigh or wrist and passed up to the heart, he says. Catheter-based procedures are also used to close an opening between the heart's upper chambers (a patent foramen ovale) or to place a device inside the heart to inhibit formation of blood clots in its upper left chamber (a left atrial appendage closure device).

Delivery of energy via catheter tips is also used to treat heart rhythm disorders, especially atrial fibrillation. But variations in both the techniques and the recommended timing of these procedures may leave patients wondering which option they should choose and when to do it.

A general cardiologist is usually in the best position to decide if you need more focused expertise from a subspecialist (see "Heart disease specialists"). But even if you've been referred to one of these experts, it's reasonable to ask about possible drug therapies or to get a second opinion from another generalist.

First doctor, second chance?

Before you undergo any surgery or procedure, be sure you fully understand the potential benefits and risks, which may vary depending on your age and any other health conditions you have. Most health care practices now let you send messages to your physician through a patient portal, which is a good first step if you have any questions, says Dr. Adler. You can send a note explaining your concerns and say you're thinking about getting another opinion, he says. "Often, your doctor will say, 'Oh, you're welcome to get a second opinion. But let's set up a video visit to discuss all your questions to make sure you're clear about the proposed treatment plan,'" says Dr. Adler. Not only are video visits more convenient, you can invite loved ones to join. Sometimes, people ask their spouse and one or more of their adult children to participate, both for emotional support and to address the family's questions, he adds.

Different treatment options

Because of the movement toward shared decision making in medicine, your doctor may offer two different treatment options and leave the decision to you. If you're not comfortable making that choice, a different doctor's advice may be welcome. In other cases, people feel frustrated with their current treatment plan. They don't feel well and aren't improving, so they hope to find a doctor who can offer other options. For instance, people with advanced heart failure may be candidates for more intensive treatments, including home infusion therapy (which delivers drugs that improve the heart's pumping ability), a left ventricular assist device (a small device implanted in the chest to support the heart's pumping function), or a heart transplant, Dr. Adler says.

Finding other experts

Your doctor, family members, or friends may be able to recommend an expert for a second opinion. Or contact a nearby medical center or hospital; they usually have online resources or call centers that can refer you to an appropriate physician for your particular problem. Check with your insurance provider to see whether the visit and any additional costs will be covered.

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