How do you know if a second medical opinion is justified?

A patient of mine was seeing a local specialist.  The parents wondered if it would be appropriate to get another opinion.  Contrary to what patients might think, most physicians are absolutely fine with this and some even encourage it.  However, patients often want to know if seeking another opinion is justified.  It is my job as a primary care provider to help families decide when or how to obtain that second opinion.

You might consider a second opinion:

  • If you do not trust (for whatever reason) the first opinion you received
  • If you have questions about the diagnosis or the recommended treatment that the physician could not answer clearly
  • If the treatment involves risk, is invasive or is of long duration or is very expensive and you have misgivings about proceeding
  • If you have time, i.e. your condition is not an immediate threat to your health or function
  • If your condition is rare

Before you seek another opinion, ask yourself the following?

  • Is delaying a diagnosis or treatment harming my health?
  • Have you received two opinions from well qualified physicians that are in agreement or near agreement, but still do not like the advice that you are receiving?  What are you waiting/hoping to hear?
  • Is your family in agreement with the doctor?  Does it make sense to them?
  • Have you independently researched your problem online to determine if other treatments exist and examined what other patients with the same diagnosis have experienced?  Have you shared your reading with the consultants?
  • Is there a center of excellence for your problem worth traveling to and what does your local expert think about that?

My patient was evaluated at Cincinnati Children’s Hospital and wondered if it made sense to seek a second opinion at the same institution.  Although members of the same division at one hospital may approach a problem similarly, the doctors have various clinical experience with varying perspectives.  Because the patient already established care there, I only had to make one phone call to arrange follow up with a different provider in the division.  Cincinnati Children’s also publishes the email addresses of their physicians online which makes it easy to contact the specialists that are seeing my patients if need be.  Although this is no guarantee that an email will be returned, most specialists sincerely want to help patients and primary care providers navigate their area of expertise.

Cincinnati is close to other large cities: Dayton, Columbus, Lexington, and Indianapolis.  I Googled providers in these regions and read about the various physicians that would be qualified to see my patient.  I called an office in Dayton.  The doctors and nurses could not talk with me because they were seeing patients, but the secretary happily gave me the head nurse’s email address.  She responded to my email in two business day with contact information and an immediate opening to see the family.

I then looked on Doximity, essentially Facebook for physicians.  Doximity has information on physicians loaded into their system even if the doctor is not an active user; however, it is easy to discern who is active.  I contacted a doctor in Lexington who emailed me back the same day.

I went to websites at Nationwide Children’s and Riley Children’s but neither had email contact information for their physicians.  Referrals could be handled by printing out a form and faxing it back.  I could have called the the hospital divisions directly and asked to speak with a nurse or doctor or called the hospital operator and requested to talk with the physician on call, but that takes longer and is not the best use of a doctor’s on call time.

Years ago the world of pediatrics and pediatric sub-specialists was smaller.  My senior partner  still knows a handful of providers on a first name basis and shares a rich history with them.  Over time I hope to build this kind of rapport, but it will likely be via social networks rather than academic meetings or encounters in the doctor’s lounge.

Seeking second opinions in medicine raises interesting questions about social media in medicine, reimbursement, and using technology to draw us all closer.  For example, I might have questions about how to help a patient while they wait for their appointment with a specialist.  Other times I might have a straightforward clinical question about a problem that I plan to manage myself.  In these circumstances: I email or call local providers or turn to physician contacts of mine on twitter who are sometimes more accessible for these kind of questions.  In either case, I spend time talking to these specialists at no cost to the patient or the insurance company.

I think most physicians like the camaraderie of sharing cases and realize that it helps patient care.  I bet at least 10% of what I send to consultants, could be accomplished with me, the patient, and the specialist via my iPhone.  Face time, texting or emailing clinical photos can be great for patient convenience, physician education and doctor to doctor relationship building, but it’s not reimbursed.  It’s certainly not part of the culture of how we see and care for patients.  Could it be?

Denise A. Somsak is a pediatrician who blogs at Pensive Pediatrician.

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