Second Opinions 101

A second opinion is the request for an expert to provide an opinion about a diagnosis, treatment or other medical suggestion when you already have an expert opinion.

With a serious diagnosis, second opinions about both the diagnosis and treatment should be considered.  Second opinions are generally covered by health insurance. The Wall Street Journal reported a 2015 study that reviewed 6,791 second opinions. There were changes in diagnosis 14.8% of the time and changes in treatment 37.4% of the time.  A 2006 study reported in Consumer Reports on Health found that a second opinion changed the original recommendations for more than half of the breast-cancer patients.

Do not delay treatment unreasonably while seeking a second opinion or allow a search for certainty to provide a reason for stalling making a decision. There is generally no harm done by delaying start of treatment for a reasonable period of time. Ask your doctor how much time you have to make a decision. To avoid unreasonably postponing getting a second opinion, set a deadline for getting the opinion. 

When thinking about who to ask for a second opinion, keep in mind:

• In addition to local doctors, you can obtain an opinion from doctors all around the country (or even the globe) or from institutions or services - often without having to travel even if the doctor is in another city. If you do have to travel, free transportation may be available.  
• A second opinion can come from an expert with the same expertise as the person who gave you an opinion or an expert with a different expertise. For example, if you have an opinion about the need for surgery from a surgeon, it may be advisable to ask for a second opinion from a doctor who specializes in using chemotherapy to treat the same condition.
• It is generally not advisable to get a second opinion from a doctor who is a close associate of your doctor. Preferably seek a doctor who works at a different institution and was trained at a different hospital and who will review your situation with doctors who have expertise other than your particular doctor's.  With cancer, it is preferable to get the opinion from a doctor who is associated with a Comprehensive Cancer Center certified by the National Cancer Institute (NCI) or an educational institution.

It is advisable to tell the doctor who gave you the original opinion that you will seek a second opinion. 

• Many people worry that asking for a second opinion will offend their doctor, or effect the quality of care they receive. In reality, these fears are ungrounded. Doctors tend to welcome a second opinion. This is particularly so when the patient has been diagnosed with a serious illness, if the recommended treatment has significant risk, or if there are several treatment options. 
• Let the doctor know why you're asking for a second opinion. For example: because of the importance of the situation or because you would like to get more information before you make a decision.
• If you're stuck for what words to use with your doctor, you might choose to begin the conversation with something like: "the information you have given me is so important and involves such major decision making on my part,that I would like to discuss it with another specialist." A competent and compassionate doctor should not object.
• If it is difficult for you to say "I want" or "I feel I need" then you can suggest that your (fill in the blank with partner, spouse, family etc.) is pushing you to get a second opinion.
• If asking for a second opinion seems to be an issue for your doctor, let the doctor know you value his or her opinion. Restate your reason(s) for wanting a second opinion.You don't want your doctor to think you are questioning her competence. On the other hand, if seeing a second opinion is a problem for your doctor, it may be good cause to switch to another doctor. (To learn more, see: How To Switch Doctors.)

Keep in mind that a copy of your medical records will be required for a second opinion.

• If your doctor refuses to make the records available, remind him or her that under the law, you are entitled to a copy of your medical records.
• If you had a scan such as an x-ray, MRI, PET scan, or CT scan,  or if you had a biopsy, get a copy of the scan or slide - not just a report. The second opinion doctor will likely insist on seeing the original as well as the report. Instead of relying on your doctor's office to arrange for copies of the originals to be sent, you can avoid delays by making the arrangements yourself with the testing facility. (Making a request in person or personally picking up the originals if they cannot be sent electronically may speed the process).
• Experts advise that:
  • If you are obtaining slides, it is best to have them sent from the original institution or lab directly to the institution or doctor who will give the second opinion. 
  • If information is on film, carry it with you.
  • If information is electronic. ask both the originating source and the second opinion if they can connect over the internet. If not, get the images on a disk and take it with you. 

If you receive conflicting opinions, ask the doctors to talk with each other to resolve the conflict and/or ask for a third or even fourth opinion. A third or fourth or fifth opinion is no different from a second opinion, although it may be more difficult to get an insurer to pay for it. If you can't resolve a conflict, trust your own gut instinct. If you find yourself looking for a third, fourth, or fifth opinion, consider whether you really need more opinions or: Are you really looking for a doctor who will agree with your idea of what you have and what should be done about it? Are you running away from the truth? The answer is likely to become clear when you stop to think about it.

Cost:

• If you have health insurance, check your policy. Most plans pay for a second opinion - and even a third and fourth one. Ask your insurance company what your policy covers and if it requires you to see a doctor within that plan. Insurance companies tend not to pay for opinions obtained over the internet instead of in person. 
• If you have to pay for a second opinion, you may be able to find a specialist who will give an opinion for free if they only have to review facts instead of an entire medical record. Alternatively, you can negotiate the fee and a payment schedule. (If  money is an issue for you, we provide information about dealing with a financial crunch.)

Keep in mind that the final decision is yours. It is your life. Too many people base their treatment decisions on, "because my doctor said so." While a trusted doctor's recommendation can be invaluable, your decision should be based on knowledge combined with your own philosophy, values, and inclination.

For more information, see the following:

• When To Ask For A Second Opinion
• How To Arrange For A Second Opinion On A Timely Basis
• What To Look For In A Doctor To Provide A Second Opinion
• How To Choose A Doctor For A Second Opinion
• Sources For A Second Medical Opinion
  • Medical Institutions That Will Provide A Second Opinion
  • Online Second Opinion Companies
• How To Prepare For An Appointment For A Second Opinion
• What To Expect During A Meeting For A Second Opinion  
• What To Do If There Are Conflicting Medical Opinions
• How To Pay For A Second Medical Opinion
• Managed Care Health Insurance: The Initial Request: How To Appeal A Denial
• What If My Doctor Insists That My Second Opinion Has To Come From Another Doctor In The Same Medical Group?

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