Half of Americans don't get a second opinion

By Renée Bacher

updated 8:48 a.m. ET Feb. 4, 2008

In 2004, I almost agreed to a risky and complicated surgery for my 7-year-old son, who had chronic sinusitis. The local ear, nose, and throat doctor said it was best, but my husband and I couldn't shake the feeling that there had to be another treatment that didn't include the chance of brain damage and blindness. So we sought out the head of otolaryngology at a nearby university-affiliated medical center.

Turns out our second thoughts — and that second opinion — were the best thing that could have happened for Benny, who wound up with a far less dangerous treatment plan that involved removing only his adenoids. He bounced back fast from the surgery, and 3 years later, he's had only one sinus infection requiring antibiotics.

As we discovered, getting another doctor's view can dramatically change a treatment plan and even a diagnosis — research finds it happens in as many as 30% of cases. In one particularly dramatic finding recently published in the journal Cancer, the recommendations for surgery changed for more than half of breast cancer patients who received a second opinion. In some cases, previously undiagnosed second tumors were discovered. Still, almost 50% of Americans never get second opinions, according to a 2005 Gallup poll. But it's key to getting the best diagnosis and treatment, says James Rohack, MD, a trustee with the American Medical Association and a cardiologist in Temple, TX. "You may even prevent an unnecessary procedure or the cost and side effects of medication you might not need."

Now you can get an elite doctor to weigh in as well: Top medical centers such as the Cleveland Clinic and Partners' Center for Connected Health (which is affiliated with Harvard Medical School) offer second-opinion services via the Internet. This practice of consulting from afar using patients' medical records and test results is having a profound effect on how problems are treated. According to Partners, although its experts changed only 5% of diagnoses during its first year of providing e-consults, 90% of the treatment recommendations differed from the referring physician's plan.

Even if you don't take the second doctor's opinion, simply knowing your options and thinking through the pros and cons can improve your care. You don't have to have a serious condition to benefit. "There may also be more than one way to approach the same problem, or there may even be a financial incentive for a physician to recommend one treatment over another," says Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, an online patient advocacy practice. "Also, doctors can diagnose any problem incorrectly."

Here's a simple plan to get a full perspective on the best way to treat your health concerns.

When you must get a second opinion
Your doctor suggests surgery. You should always question elective (planned, nonemergency) procedures, especially if a less-invasive alternative is available. (Insurance, including Medicare, frequently requires second opinions in these cases.)

She prescribes long-term use of medications with side effects. Ask about non-drug-related options — especially if your physician is prescribing medication to prevent a disease, a growing practice. Called primary prevention, this approach means that if you have borderline high cholesterol but a family history of heart disease, you may be prescribed a cholesterol-lowering drug for your lifetime. Another physician might simply advise you to exercise regularly, stick to a low-fat diet, and check your cholesterol more frequently.

You're not getting better. For something like a rash that won't go away, it's always best to see your general practitioner first. If you're still scratching 2 weeks later after trying several treatments, ask him for a referral to a dermatologist rather than seeking out a specialist yourself, suggests Kate Clay, RN, program director at the Center for Shared Decision Making at the Dartmouth-Hitchcock Medical Center in Lebanon, NH. "Keeping doctors in the loop allows them to know what's working and what's not. That's how they learn to practice good medicine." And that ultimately improves your care.

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