A matter of opinion

Second opinions help patients weigh options.

Most of us will face at least one important medical decision in our lives. It may involve starting a medication, being tested for an illness, or undergoing a procedure. Sometimes the choice is clear-cut, but when it isn't, seeking a second opinion before starting treatment is recommended. Second opinions give patients (and their families) more information to weigh their medical options.

Usually, the doctor reviewing the case has special expertise in the suspected problem; with a complicated illness, like cancer, a number of specialists (pathologists, radiologists) might be called on to offer a second opinion. Sometimes a third, tie-breaking opinion is helpful in resolving conflicting advice, but going beyond that and getting too many opinions could cause harmful delays.

A second opinion may simply confirm a first diagnosis or treatment recommendation, but that doesn't mean it was a waste. If the two opinions agree, so much the better, and it's certainly reassuring. A second opinion can be helpful just because another doctor may explain things in a way that's more understandable to you.

But a new set of professional eyes and ears can shift the whole approach. Pathologists at Johns Hopkins reviewed over 800 cases referred to the hospital for head and neck cancer surgery between 1990 and 2000. They found that second-opinion looks at tissue samples led to changed diagnoses in about 7% of the cases, including some from benign to malignant, and the other way around.

Second opinions can also save money by steering treatment away from expensive tests, medications, or procedures, so insurers often encourage them and may, in fact, require them for some situations. Still, check with your health plan before getting a second opinion to see whether the visit and any additional costs will be covered.

There are several ways to gather more medical advice. A primary care doctor may refer a patient to someone who has more experience treating the disease. But if you want another expert opinion, asking the doctor, nurses, or family and friends for names is a good step. Many hospitals offer second-opinion services, and there are also private companies that provide second opinions by reviewing a patient's records, but do some homework to make sure it's a reputable business.

Five surprising things about second opinions

1. They're less common than you think. A 2010 poll showed that 70% of Americans don't feel compelled to get a second opinion or do additional research, despite the abundance of medical information at people's fingertips. Surprisingly, the confidence factor cuts across patients' educational levels.

2. Your doctor won't be mad. It can feel awkward to bring up, but doctors generally welcome having their patients seek second opinions. Dr. Gregory Abel, a blood cancer specialist at Harvard-affiliated Dana-Farber Cancer Institute, says, "If you have a doctor who would be offended by a second opinion, he or she is probably not the right doctor for you."

Cancer survivor Jessie Gruman says every doctor she interviewed for her book AfterShock recommended getting at least one additional opinion to verify a serious diagnosis and develop a course of action. Patients are free to go back to their original doctor for treatment, although many stick with the consulting expert.

3. Discuss what matters to you. Although your primary-care physician may know you well, a specialist may not — at least not at first — and may focus on different aspects of the treatment. In a study published in Health Expectations in 2010, investigators asked a group of patients and providers to rate facts and goals around treatment choices for early-stage breast cancer and found several areas of disagreement. For example, patients were more likely than providers to focus on possible side effects from chemotherapy and hormone therapy.

4. Conceal the first opinion? Researchers based at Ben-Gurion University of the Negev in Israel surveyed hundreds of orthopedic surgeons and neurologists to explore whether specialists giving second opinions are influenced by the first one (the results are not yet published). After distributing hypothetical patient scenarios, they found that orthopedic surgeons were more likely to recommend a more "interventionist" treatment if they knew the first physician had advised one, and they leaned toward a more conservative approach if the patient hadn't yet received an opinion. No such effect was found among the neurologists.

This study might suggest that you'd get more objective advice if you withheld information about the first opinion from a doctor offering a second one. But as a practical matter, that's going to be difficult to do — and perhaps isn't so advisable. Most physicians, ethicists, and patient advocates recommend erring on the side of open communication.

5. For the record. Even if the consulting doctor doesn't know the first opinion, he or she will want to see your pathology slides, imaging scans, lab results, and other parts of your medical record before offering an opinion. But according to ongoing research by Dr. Abel and colleagues, about 20% of patients are sent to see a specialist without any formal communication from the first doctor. So prior to your appointment, you should contact the office of the doctor providing the second opinion to see what you should bring or have sent. It's also a good idea to bring along a notebook so you, or someone who is with you, can jot down notes.