When to get a second opinion

By Tara Bannow
Published Jan 31, 2014 at 11:27AM / Updated Feb 12, 2014 at 06:03PM

Seeking a second opinion is a personal decision. However, experts say, there are still important things that should be kept in mind in every case.

When should you get a second opinion?

Seek a second opinion any time you feel uncomfortable with your diagnosis, said Erin Moaratty, chief of mission delivery with the Patient Advocate Foundation, a nonprofit that helps patients manage health care struggles. Second opinions tend to happen more among patients who’ve been dealt more serious diagnoses, such as cancer, multiple sclerosis or Type 1 diabetes, she said. “All of those things would probably trigger some uncertainty in their minds, and they may want to seek out a second opinion at that point.”

If you ever hear a doctor say, “Nothing can be done for you; there is no treatment available and you should seek hospice care,” get a second opinion, she said. There may be ongoing clinical trials you could enroll in, or alternative options your doctor didn’t consider, she said. Doctors often give what’s called a differential diagnosis, a list of several conditions the symptoms might mean, said Carla McKelvey, a general pediatrician in Coos Bay and past president of the Oregon Medical Association. In those cases, a second set of eyes looking at the lab tests and imaging studies can be beneficial, she said.

Can you afford it?

Before picking up the phone to make the appointment, first check with your insurance provider and find out whether your policy covers second opinions. Most companies cover them — especially if your primary care doctor recommended it — but people need to make sure the second physician is covered under their insurance company’s provider network, Moaratty said.

Rare conditions require specialists, and often there are only a few of those in a community, she said. However, it’s also important that the second opinion comes from a physician who specializes in your condition. If the initial opinion came from an oncologist who specialized in breast cancer, for example, and your diagnosis was carcinoma, you’d want to see a doctor who specializes in your specific type of cancer, Moaratty said.

“You just want to make sure you’re prepared mentally and financially for what might come,” she said. “You want to make sure your insurance will pay for it.”

Medicare will pay 80 percent of the cost of both a second and third opinion, according to the PAF. Patients who belong to a Medicare Health Maintenance Organization are entitled to a second opinion, but some plans require a referral from your primary care physician, according to the PAF.

Insurance companies typically will not pay for lab tests if they were already performed for the diagnosis, so be informed about which tests you already had done, and get copies of them.

Should you tell the first doctor?

The medical system has shifted toward a patient-centered primary care home model in which primary care physicians oversee patients’ care and coordinate their services, McKelvey said. That means that when it comes to seeking a second opinion, the most important thing to do is to first have a conversation with your primary care doctor, who likely will be able to direct you to the appropriate doctor for a second opinion. “They can make sure the patient is directed to someone who is well-qualified,” McKelvey said. “Google is great, but it doesn’t always provide the best choices.” If the first doctor knows where else the patient is seeking care, he or she can communicate with the other doctor and share information.

Letting the first doctor know also can save money by way of preventing lab tests or X-rays from being duplicated. “If they don’t know about that, then they may order the same tests,” McKelvey said. “Then (the patient) may have unnecessary exposure to radiation if they get extra X-rays. They may have repeat labs they don’t necessarily need. So it’s really important that that conversation stays open and transparent on both sides.” •

Greg Cross / The Bulletin