Imagine you have heartburn. For years you’ve managed with antacids, but one day you’re struggling to swallow steak without vomiting. Your gastroenterologist finds a large hiatal hernia, an enlarged opening of the diaphragm trapping part of your stomach. She sends you to a surgeon, who says a surgical procedure will correct the problem but could permanently alter your digestion.
This is your first time hearing that surgery might help you, and you’re just not sure: Should you follow the surgeon’s advice?
As a surgeon focusing on specialized esophagus and stomach procedures, I often treat patients who may want to seek a second opinion. I’m often asked to provide second opinions, too.
Seeking a second opinion is a patient’s right, and it is widely accepted in medical practice today. But it can also feel daunting. You may worry about offending your physician or making them feel you don’t trust them. And it’s not always clear whether your condition, or a treatment the doctor recommends, is straightforward or more complicated. Getting a second opinion also takes additional time and energy.
Understanding the origins of second opinions, how they are used today and what steps you can take to decide whether you should obtain one can help you navigate your care with more confidence.
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A brief history of the second opinion
Through the turn of the 20th century, physicians generally embraced a one-way view of the doctor-patient relationship in which they wielded the medical knowledge and technical expertise and decided what treatments best served their patients. But in the early to mid-20th century, a growing recognition of the principles of patient rights and autonomy began to emerge alongside the modern foundation of medical ethics.
In the wake of Nazi atrocities during World War II, the Nuremberg Code and later the Belmont Report established protections for human research subjects. A series of landmark legal cases required doctors to discuss the risks and benefits of surgical procedures with their patients and obtain informed consent – a term introduced in 1957.
As respect for patient autonomy grew, so too did an emphasis on patient advocacy and empowerment. In 1972, researchers at Cornell University Medical College launched the first known surgical second opinion program. Collaborating with insurance companies, they made sure patients could obtain a second surgical consultation before any planned procedure. More than 7,000 patients participated in the program in its first six years – and 28% of them declined the original treatment plan after obtaining a second opinion.
Today, most insurance plans, including Medicare and Medicaid, provide coverage for second opinions regarding surgical care, serious injury or illness – especially cancer. Patients may still be responsible for a percentage of the cost, so anyone considering a second opinion may want to check their plan’s benefits.
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The value of a second opinion
One type of second opinion initiated by doctors when required by insurance companies or hospital protocols is called a mandatory second opinion. It is most often seen in cancer care, where doctors at some smaller hospitals routinely collaborate with specialists in larger national cancer centers on a broad range of questions, from confirming a diagnosis to selecting the right medications.
Routine second opinions confirming biopsy findings, for example, resulted in major diagnosis changes in about 7.5% of patients, one study showed. Other studies found that this type of second opinion changed the interpretation of imaging scans or overturned a decision about undergoing surgery, about one-third of the time.
Patients, on the other hand, may have different reasons for requesting second opinions. For example, they may want to find a doctor with more experience with their health condition, or someone who communicates in a way that is clearer to them. Patients might also seek a second opinion if they are experiencing symptoms that are difficult to fit into one clear diagnosis.
Sometimes, a patient with complications or poor results from a prior treatment may need guidance. Or, if a doctor is recommending a course of action that is invasive, has a high risk of side effects or might affect long-term quality of life, a second opinion may boost a patient’s confidence in that course or provide an alternative.
When patients seek a second opinion regarding a cancer diagnosis, they make major changes to their treatment plan in up to 42% of cases, according to one study. For more common issues such as fatigue or abdominal pain, a second opinion might yield a new diagnosis only 10% of the time, but 70% of patients receive advice they find helpful.
It’s not clear whether patients who obtain a second opinion are more likely to complete a particular treatment – but getting another perspective often leads patients to feel more satisfied, confident and informed in their care.
Tips for navigating a second opinion
Hopefully, knowing how empowering second opinions can be both for patients and clinicians can help you feel less guilty or awkward asking for one. Here are a few proactive steps you can take to help you decide whether to seek a second opinion – and to streamline the process if you do.
Plan ahead. Contact your insurance company in advance – if possible, even before your first visit about your concern. The insurer can tell you about your coverage for any specialty care you may need and whether a second opinion would be covered under your policy.
Come prepared to maximize your appointment. Before your initial visit, think through how you’ll take notes. Bringing a trusted friend or relative to your appointment may make this easier. Start a running list of questions you can update as they occur to you.
This can help focus your concerns and make the most of your time with the first provider. If you decide to seek a second opinion, this documentation can also define key points you may want clarified or confirmed.
Gauge your comfort with the initial provider’s expertise with your symptoms or condition. Questions you might ask include: Is this a rare or common diagnosis? Are my symptoms typical? Is this a procedure or treatment typically carried out by providers with special training? How often do you perform this procedure or treat this illness? How often are patients with my condition treated at your hospital?
Ask whether the provider has any printed information, research studies or reliable websites they can share to reinforce your discussion.
If you have a rare diagnosis, unusual symptoms or are seeing a provider who doesn’t frequently treat your condition, a second opinion may be more likely to improve your care.
Think about the quality of provider-patient communication. Were all your questions answered? Did the visit feel rushed? Was your provider a good listener? If the visit fell short, either in terms of time or communication, a second opinion can help you feel heard and understood, and demystify points of confusion.
On the other hand, if the discussion was clear and left you feeling confident in your care, but you would still feel more comfortable with another perspective, you can be honest with the doctor about it. Providing feedback to your initial physician is often helpful in maintaining a positive and trusting relationship. Many patients choose to return to their first clinician after exploring other options.
Pin down the time frame for a second opinion. Ask the provider you initially see whether the diagnosis or recommended treatment is urgent or time sensitive. Some medical and surgical treatments must be scheduled weeks or months in advance, while others are more flexible. Confirming this time frame helps your doctor plan ahead, but more importantly it helps you figure out how much time you have to consider your alternatives without delaying needed treatment.
