When and how to seek a second opinion-a patient’s perspective

 

NK Sethi ¹, PK Sethi ²

 

¹ Department of Neurology, Comprehensive Epilepsy Center, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.)

² Department of Neurology, Sir Ganga Ram Hospital, New Delhi (India)

 

 

 

 

 

 

 

Address for Correspondence:

NK Sethi, MD

Department of Neurology

Comprehensive Epilepsy Center

NYP-Weill Cornell Medical Center

525 East, 68^th Street

New York, NY 10021 (U.S.A.)

Email: sethinitinmd@hotmail.com

 

 

There are times when a second opinion is not only appropriate, its necessary. This is true both from the patient’s as well as the doctor’s perspective. Since the patient technically has more to lose, it is imperative that patient’s know when and how to seek a second opinion. This is more significant in clinical neurology especially when one is handed down a diagnosis of a neurodegenerative condition like young onset Parkinson’s or Huntington’s disease. Diagnosis of a disease like amyotrophic lateral sclerosis (ALS) is essentially like signing off on a death sentence. Patients and caregivers are distraught and may not know what to do. Some may trust their doctor and agree to his or her management plan. But what if he is wrong? Maybe there is something out there that may help me. Maybe my doctor does not know about it. Even if the diagnosis is correct some may not be comfortable with the line of care. It is at times like these that the question of seeking a second opinion crops up.

Is my doctor right? is frequently he first question that comes up in the minds of many patients when handed down a diagnosis of a chronic or life threatening illness. Could he have made an error? Patients and caregivers may approach this in a couple of different ways. Some will inherently trust their physician skill entrusting themselves to his care. Others may seek to reassure themselves of the certainly of the diagnosis in one of many ways either by asking more questions of their physician or seeking information on the Internet. A fraction may decide to seek a second opinion. A question, which arises in the minds of some patients and caregivers, is would my doctor mind if I request a second opinion. Would he take it personally? Most doctors do not get upset if their patient requests a second opinion but some do. Many doctors may actually encourage their patients to get a second opinion especially if they have a rare condition or an atypical presentation. In these times of increased medical litigation, one form of defensive medicine practiced by doctors is to get a second opinion.

Now the question arises whether you want your doctor to suggest a specialist or do you want to do the spadework yourself. Having your doctor refer you to a specialist for a second opinion has many advantages. It may cut down on your time and effort and more importantly ensure that you are seen by someone who truly is a specialist in the malady that plagues you. Your own doctor may be willing to pick up the phone and call the specialist to apprise him of your case history. Relevant investigations can be quickly faxed to the specialist office. This ensures you are seen in a timely manner. Importantly the specialist has all pertinent records including results of tests down at his disposal at the time of your visit. Remember if you go to see a specialist without lab results, his opinion is at the most limited.

One must ask oneself what do I seek from the second opinion? Is it confirmation of my diagnosis? My diagnosis is confirmed but I want to know what treatment options are available or I just want a better explanation for my disease. Stick to what you seek from your second opinion and do not get side tracked.

Go prepared at the time of your second opinion visit. As your time with the specialist is going to be limited so make the best of it. Have your case history summarized. A good way is to have it typed out in a chronological order. When did the problem start, how did it progress and the treatment options that have been pursued. This shall save precious time and ensure that the specialist has all relevant data at his disposal prior to giving a second opinion.

Are there any cons to seeking a second opinion? While there are no real cons to seeking a second opinion, certain issues should be borne in mind. Remember there is no guarantee that a second opinion is right. The specialist may or may not voice the same diagnosis as your primary doctor. One can get side tracked and end up wasting precious time and money. Time and money that could have been used to begin treatment earlier. Do not get into the trap of doctor shopping, shopping till you get an opinion that you want to hear. Too many opinions have the potential for confusing you and leaving you undecided.

Seeking a second opinion is your prerogative as a patient but use it wisely.