Doctors' Love/Hate Relationship With Second Opinions

Neil Chesanow


June 18, 2015

In This Article

A Common Culprit: Poor Communication

The most common reason that patients seek a second opinion, according to the doctors we asked, is either poor communication or lack of personal rapport between physician and patient.

"Second opinion requests may not always arise from a missed diagnosis or mishandling of a case but because the patient is uncomfortable with their healthcare provider," Dr Shirley maintains. "If we touch our patients and thoroughly listen to their concerns at every visit, we'll get fewer requests for a second opinion."

In Dr Miller's experience, misdiagnosis or mistreatment accounts for a minority of second opinion requests. "I see a lot of patients for second opinions," she says. "Only about 20%-25% of the time would I recommend a treatment different in some way than what they've had before."

Most patients who come to Dr Miller seeking a second opinion do so for two reasons: "They didn't feel like their doctors were listening to them and hearing their concerns, and I gave them a better, more complete explanation of their situation and treatment options. I hear that a lot from people for whom I did not recommend any different treatment. They were getting exactly the right therapy. But they didn't feel like they got a thorough discussion or a good education about their situation and their options. They were told: 'This is what you have, and this is the treatment. You'll come in on Monday and do this, and then on Friday you'll do that.' There was no sense that anything else was considered. They wanted to know: 'Why is this the best treatment for me?'"

"Part of that may not be fair" to the initial doctors, Dr Miller hastens to add. "If you're the second or third person seeing someone, you will almost always sound smarter. You're going through the same information and the same explanations. The second or third or fourth time through, it starts to make more sense to patients. Nuances that their first doctor may have covered, they start to hear."

"Some physicians are better at relating and communicating the information to the patient, no doubt about it," Dr Varn agrees. "Sometimes the second opinion is just helping the patient understand the information in a better way in terms of what problem they have or what their options are. Physicians have different communication styles, as do patients. So the match is not always perfect. One physician might be a better match for a specific patient."

When A Second Opinion Is Encouraged

While some physicians may bridle at having a patient seek a second opinion, often it's the patient's doctor who seeks another doctor's take, for a variety of reasons. Chief among them is uncertainty about what is wrong with the patient.

"Being in family medicine and geriatrics, I don't get asked for a whole lot of second opinions as much as I might send somebody for a second opinion," says Dr Davant. "That would be particularly true with, say, an older patient who almost certainly has either Alzheimer's or another type of dementia, or someone who's not getting better, and I'll say, 'It's time we get a neurologist to look at it.'"

"Second opinions can be diagnostic or therapeutic," explains Dr Mandrola. "A second opinion could be sought if you or the patient is not sure that the diagnosis is correct. One of the biggest reasons for second opinions is not so much which treatment the patient needs but whether to treat or not. One of the things I end up recommending a lot is no treatment."

For older patients with atrial fibrillation, "sometimes just living with the disease is safer and better than doing anything else, and many of my second opinions are just education about what the disease is," Dr Mandrola says. "A lot of times, in giving a second opinion, the disease I see patients for is simply part of the aging process. Or it's natural variation on a low heart rate that the patient is concerned about. To which I may say, 'Yes, you have a low heart rate, but if it worries you, stop checking it.'"

"Second opinions often involve a serious procedure or a surgery," says Dr Mintz. "As a primary care physician, I don't do surgeries or serious procedures. However, a patient may say, 'You referred me to Dr so-and-so and they want to do X procedure. What do you think? I’m really concerned.' I always tell them to get a second opinion. In fact, I recommend that anyone get a second opinion on a serious elective procedure."

But it depends on the situation.

"If you have gallstones, and a physician says your gallbladder needs to come out, then that's a bread-and-butter surgery, and there's usually pretty good consensus that if you're having gallstone pain, you've got gallstones," Dr Mintz adds. "Most experts would say, 'Go ahead and get your gallbladder taken out.'"

"If there's an emergent surgery—say, you have appendicitis, and you may die—you don't need a second opinion for that," Dr Mintz elaborates. "But the trickier things—like should I get my knees replaced? Should I get my spine fused? A lot of these sort of elective surgeries, which are designed to improve function and relieve pain, are controversial because they don't always do that. In those cases, I'll always say, 'Get a second opinion.'"


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