How To Get a Second Opinion

Every day, doctors are on the hook for making serious—sometimes life or death—decisions. Research in 2010 estimated that the average physician makes about 158 decisions a day concerning patient tests, diagnoses, procedures, medications, treatment plans, and more. A newer study, published in 2021, suggested that this decision fatigue takes a toll. Docs are human, too, after all, so medical mistakes happen. For example, a 2022 report from the US Department of Health and Human Services’ Agency for Healthcare and Quality found that about one in 18 people who go to the emergency room get misdiagnosed. Even Oprah had a thyroid problem that for years went misdiagnosed as a heart condition.

Now, this report isn’t meant to belittle the value of today’s modern medical field or the tireless work doctors and nurses do to keep their patients healthy. Healthcare work was demanding long before the COVID-19 pandemic, which has made it even worse. But these points do underscore that, in some cases, it can be extremely beneficial to get a second opinion.

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What are the benefits of getting a second opinion?

Most patients won’t need a second opinion for every medical concern, says F. Perry Wilson, MD, Associate Professor at Yale School of Medicine and author of How Medicine Works and When it Doesn’t: Learning Who to Trust to Get and Stay Healthy. “While we often imagine that second opinions might leave us with a completely different diagnosis or treatment plan, this is actually rarely the case,” he says. “But second opinions have a lot of value in terms of reassurance, to know that you are getting the right treatment for the right problem.” They also offer the opportunity to ask questions you may have forgotten (or were too overwhelmed to ask) and learn more about the options available to you. “And of course, it’s important to ‘gel’ with your doctor—sometimes a second opinion turns into a new doctor-patient relationship, and that’s okay.”

Still, “healthcare and medicine are very complex—and it’s a rapidly evolving field,” adds Peter Rasmussen, MD, Chief Clinical Officer at The Clinic by Cleveland Clinic. “It’s very difficult for physicians, even if they’re specialized—say, an orthopedic surgeon—for them to be broadly an expert in all aspects of orthopedic surgery.”

That’s why getting a second opinion can be particularly valuable in more complex healthcare situations, as you gain insight from a physician who focuses their time in a very narrow area of medicine and is up-to-date on the latest discoveries and advances.

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When should you get a second opinion?

So, how do you know if you need a second opinion? Dr. Wilson and Dr. Rasmussen point to four scenarios when tapping an additional expert for their input is well worth your time.

Chronic condition diagnosis

“As we get older, we are faced with more and more health issues that we likely to ‘have to live with’ as opposed to [getting a] cure,” he says. “But it’s important to make sure these diagnoses are made correctly—and a second opinion can give you the confidence that you know what you are dealing with.”

Researchers from Johns Hopkins University found that cancers and heart conditions are among the most commonly misdiagnosed health conditions, for instance. Other reports show that the misdiagnosis of type 2 diabetes as type 1 diabetes is common in older adults, and chronic kidney disease is underdiagnosed. Plus, many chronic conditions are extra tricky to diagnose due to:

• Lengthy symptom-tracking requirements, like with diagnosing irritable bowel syndrome or Lyme disease

• Presenting similar symptoms to other conditions, such as celiac disease, fibromyalgia, or thyroid conditions

• A lack of standard tests or disagreement among the medical community about how to diagnose, like with Parkinson’s disease, multiple sclerosis, or polycystic ovary syndrome

Long-term treatment plans

“Going on an antibiotic for a week or two for an infection is one thing, but for medications that you may be taking for years, speaking to more than one expert can help elucidate the options, side effects, and long-term costs,” Dr. Wilson says.

Intensive treatment plans

“It can be a good idea to seek a second opinion when the [prescribed] treatment is costly, toxic, or painful—think: Chemotherapy for cancer or non-emergency surgery,” Dr. Wilson says.

In some cases, there may be less invasive or noninvasive treatments to consider. For example, a 2021 study published in The BMJ found that for six of the most common orthopedic operations, surgery offered little advantage over clinical interventions like physical therapy and drug treatment.

“There have been dozens of times when patients have come through our program and were told that they need this heart operation or this orthopedic surgery operation,” Dr. Rasmussen says. “And they don’t meet current indications, or an adequate trial of physical therapy hasn’t been given. I think if anyone’s contemplating a major surgery [or has a] high complexity, rare diagnosis, it’s worth a second opinion.”

You’re not getting better

“Broadly speaking, if you’re on a treatment path, and you don’t seem to be getting better, that might be a trigger that perhaps the diagnosis is wrong or the treatment plan that you’ve been given locally is not correct,” Dr. Rasmusseun says.

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How should I ask for a second opinion?

Dr. Wilson and Dr. Rasmussen both emphasize: If you want a second opinion, absolutely ask for it. “Many patients are worried about [offending their doctor], but I assure you we do not mind,” Dr. Wilson says. “Most of the time we are delighted that you are taking control of your health—that means we’re working with a patient who is going to fight as hard as we do.” Often, your doctor can recommend colleagues that are particularly knowledgeable in a given area, he says. And in general, most health insurance plans will pay for that second opinion (but contact your health insurance carrier first so you’ll know what to expect).

Today’s remote medicine options are making it even easier for people to access the specialist opinions they need. “Let’s imagine somebody from rural Kentucky wants to come to Cleveland for a second opinion,” Dr. Rasmussen says. That means time off work, potentially needing a family member to come along, and travel and hotel expenses. But if you’re at the point where you have a diagnosis and proposed treatment plan, he says, that means the medical evaluation is usually complete. And since medical records are generally electronic, the specialist can access your data and meet with you virtually to discuss what’s going on. But if more testing is necessary, you can still get that done locally while getting your second opinion remotely. “Pathology and biopsy specimens, as an example, have been sent through the US mail for decades in a timely fashion that really allows for a remote reevaluation,” he explains.

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