Patient Guidelines: 2nd & 3rd Opinions

Last Revised: 08/11/202

by W. Kolber, MHA

Confirm Your Diagnosis

The first diagnosis is not always the correct diagnosis. A diagnosis is what your doctor thinks is wrong, not necessarily what is wrong. The common process that doctors use to make a diagnosis is called differential diagnosis. This includes using clues from your symptoms, tests, their own knowledge and experience, and sometimes additional input to list the possible causes of what is wrong. Then they begin eliminating the ones that do not fit the clues. Once all diagnosis that don’t fit are eliminated the one that’s left is the diagnosis.

Although doctors are well trained and often very experienced there are more than 95,000 preventable deaths in the U.S. each year, and many misdiagnosed diseases. Misdiagnosis is used in aPatientsPlace; Patient Guidelines to include errors in clinical diagnostic tests or laboratory results, mishandling of results, and improper follow-up.

Based on the analysis of over 20 different malpractice studies, which analyzed a wide variety of issues ranging from the percentage of adverse outcomes occurring in a particular setting to the number of law suits citing a particular disease, the most common misdiagnosed diseases are Breast Cancer, Stroke, Melanoma, Lyme Disease, Lupus, Gynecological Cancer, Celiac Disease, Colorectal Cancer, and Hematological Cancer.

The point is that your first diagnosis is not always accurate. To confirm a diagnosis…

  1. Get copies of your medical records and test results. Do not rely on your doctor and the lab to send your results to another doctor.
  2. Ask your doctor why s/he excluded other options. It is possible that your doctor misunderstood some of the clues.
  3. Get a second opinion. If you get a second opinion that is different from the original diagnosis you should call your insurance provider and request coverage for a third opinion from an expert in your illness or condition.

 When to Get Another Opinion

You should get a second opinion in all cases when you are diagnosed with a major illness or condition. This is important because you must be as confident as possible that you know beyond a doubt the illness or condition you are dealing with and what your options so you can make the best treatment decisions for yourself.

Tip: Often your insurance provider will require a second opinion before approving payment for a costly treatment.

Since doctors are viewed by most people as trusting, caring and honest it’s common to feel like a doctor will be offended when told that a patient would like the opinion of another doctor. Do not let this feeling prevent you from getting a second opinion. Doctors need to get comfortable with their patients’ seeking additional information and the opinion of another doctor. In most cases they should encourage it.

In summary, a second opinion is probably a good idea when you are…

  • Diagnosed with a life-threatening illness or condition.
  • Told you need a major surgery, or an invasive test.
  • Do not have complete confidence in the original diagnosis.
  • Feeling that you need to speak with an expert at treating your illness or condition.
  • Unhappy that your regular doctor has not diagnosed your problem.
  • Having trouble talking with your current doctor(s).
  • Not seeing improvement in your medical condition.
  • Told a second surgery is recommended.
  • Having multiple medical problems

You may also feel that you want the opinion of an expert at treating your condition to be 100% confident that you understand your treatment options, and their likely impact on your life.

Finding a 2nd Opinion Specialist

Step 1: Tell your first doctor that you would like the name of a specialist so you can get another opinion. Any doctor worthy of the practice of medicine will be supportive. If your doctor is not supportive, that is a warning sign that means you most definitely need a second opinion. Find out what procedures you or your first doctor needs to follow to ensure your provider pays for the second opinion.

 You should not be looking for a doctor that your original doctor plays golf with. You are looking for an expert at treating your condition. If you need to find the best doctor on your own here’s a link to the Patient Guideline; “Finding Doctor Right.”

Do not go to a doctor from the same practice unless you are 100% confident that the doctor you are being referred to is a bona-fide expert. Check with your health insurance provider to find out what is needed to ensure that they pay for the second opinion.

Step 2: Contact your health insurance provider and ask for a list of in-network specialists that you can review. See if your doctor’s referral is in the list. If not, find another specialist.

Step 3: Review the list from your health insurance provider and select two or three physicians to call. Chose the specialists based on their training, experience, location, office ours, hospital affiliations, and any other criteria important to you.

Step 4: Write down the questions you want answered, and make sure you get very specific answers. You may also want to have someone you trust review your questions.

One of the most important questions you need to ask is “what information the doctor needs to issue their second opinion.”

Other questions you may want to ask are a little different than the questions you asked your first doctor. Use the list below as a guide:

  • What is the likelihood that my medical problem could have a different diagnosis than the one I was given?
  • What are the traditional and alternative forms of treatment for my condition?
  • Which treatments typically have the best results?
  • What are the likely outcomes if I wait, or if I don’t have the recommended treatment?
  • What are the risks associated with each of the possible treatment(s)?
  • Are there any side effects or residual effects from each treatment option?
  • How will each treatment improve my health, or the quality of my life?
  • How long is the recovery period?

Step 5: Continue learning as much as you can about your illness or condition. If possible, try to meet face-to-visit with the doctor providing the second opinion. There are great hospitals like the Mayo Clinic that will give you their expert opinion based on reviewing your tests and records, too. While this can be valuable it is not the same as seeing the doctor in person.

Tip: You will also need copies of your medical records sent to your second doctor before the appointment. Your original doctor should be able to do this for you.

Step 6: During your office visit with the doctor giving you a 2nd opinion you want to make sure you understand the second doctor’s opinion about your diagnosis. You also want to know if additional tests might help to provide a clearer understanding of your condition and your treatment options.

If the diagnosis from the second doctor is different than the first or s/he is not confident in the original diagnosis you may want to consider a third opinion. Once your original diagnosis is confirmed by another doctor who specializes in your illness the likelihood that the diagnosis is accurate is much higher.

Tip: Most important, make sure that you get a written copy of the second doctor’s findings, and that you know who to call if you have any questions after reviewing that report.

In today’s medical system, you can also get a remote second opinion from experts at leading medical institutions. Insurance often will not pay for online second opinions. Make sure you understand your cost up front. Some of the leading providers are:

Cleveland Clinic’s MyConsult Online Medical Second Opinion; (216) 444-3223. This group is affiliated with the world-renowned Cleveland Clinic. The group charges $565 for an online second opinion. If a pathologist is needed (with cancer, this is usually the case), there is an additional charge of $180.

Partners Healthcare Online Second Opinions is a group affiliated with Massachusetts General Hospital, Dana-Farber Cancer Institute, Spaulding Rehabilitation, Brigham and Womens Hospital and others. At the time of researching this Guideline the basic cost was $495 for a specialist opinion. Radiology and Pathology reviews cost an additional $200 and $250 respectively.

MDAnderson Second Opinion Pathology (713) 792-3112. This service is from the world-renowned MD Anderson, and often provides results within 48 hours. However, MDAnderson’s service does not discuss or recommend treatment options.

Dana-Farber’s Online Second Opinion Program is powered by Grand Rounds and the Dana-Farber and Boston Children’s Second Opinion for Children offers second opinions for children.

Tip: If you still need additional help go to aPatientsPlace.com and schedule a free phone or video call consult.

As you take each step on your journey to well-being, remember that research shows that patients who are more involved in their health care tend to get better results and be more satisfied.

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