7 Steps to Getting a Second Opinion

Seeking one may give you more confidence—and more treatment options. Reap the benefits by following this plan.

When your doctor gives you a diagnosis or treatment plan you’re not sure about, it’s smart to get a second opinion. But from where? How do you go about it? And won’t your doctor be offended?

We’ll start by answering that last question: Nope.

“Second opinions are welcomed by the medical community,” says Scott Mancuso, M.D., a chief clinical officer at Landmark Health, which provides health care for patients with multiple chronic conditions in locations across the country.

“Your providers want you to be certain of the decisions you’re making,” says Dr. Mancuso. “We recognize that second opinions help you get the best treatment plan in a very complex world.”

By following a few best practices, you can make the process easy and get the most value out of your visit to doctor number two.

Ultimately, seeking a second opinion can help you feel more confident in your diagnosis. And it may even reveal more treatment options, boosting the chances you’ll find the right plan for you.

It all starts with knowing when to seek a second opinion. Any of the following scenarios warrant one:

• You have symptoms but no clear diagnosis.
• Your doctor says nothing’s wrong, but you’re not getting better.
• You have a diagnosis, but you’re not improving with the usual treatments.
• You’ve been diagnosed with a serious or tricky-to-identify illness.
• Your doctor’s visit felt rushed or you still have questions about your diagnosis.
• The treatments are serious or expensive, or include surgery.

Whatever your reasons, be sure to follow these seven steps.

Step #1: Talk to Your Primary Care Physician

We repeat: Don’t worry about hurting the doc’s feelings. Doctors are taught to welcome second opinions, and most do.

Your best bet is to recruit your doctor into the decision-making process, says Ardeshir Hashmi, M.D., director of geriatrics at the Cleveland Clinic.

“Say, ‘I really appreciate everything you’re doing for me, and here are my concerns,’” suggests Dr. Hashmi. “Then it becomes a conversation.”

Your doctor can help you decide the right expert to consult and what questions to ask. And getting your doctor’s input may help you feel more confident in your decision.

What if you’ve already been to see one specialist and are interested in seeking a second opinion from another? Talk to your primary care doc about that too, suggests Dr. Mancuso.

For serious or complex illnesses, your primary doctor can help you manage your “team” of health experts.

“Your primary care physician should be your quarterback of care,” says Dr. Mancuso. “They may not be writing the prescriptions or doing the procedures, but they know what the procedure is intended to do, and the risks and benefits.”

And if your doctor was the one who suggested getting a second opinion? Make sure you understand why, says Dr. Mancuso.

Step #2: Check Your Health Coverage

Medicare Part B covers second surgical opinions for surgeries that are medically necessary but not an emergency. Many Medicare Advantage Plans and other types of private insurance may also cover second opinions, but they may require prior authorization or have other rules. Always check with your health plan about coverage and costs.

If you feel out of your realm discussing medical terms, ask the health plan representative if they have a medical expert who can talk to your first doctor directly, suggests Dr. Hashmi. That way, your doctor can be the one to explain the why you might need a second opinion.

In some cases, if your health plan doesn’t have an in-network provider who offers what you need, it may authorize an out-of-network provider of your choice. But again, check about coverage and costs.

Step #3: Decide on Doctor Number Two

Which doctor you go to depends on your circumstances and goals, so make sure you’re very clear on why you want a second opinion.

Let’s say you’ve been told you need back surgery but that’s not what you want. Consider seeing a specialist in minimally invasive options, says Dr. Mancuso. Or perhaps a pain specialist who can suggest alternative ways to manage the pain.

Ideally, that back surgeon you saw should be able to recommend someone. Otherwise, you can ask your health plan rep for guidance. Health plans may be more up to date on new treatments, says Dr. Mancuso.

“The simple way is to go where the expertise is,” adds Dr. Hashmi. If you’ve been diagnosed with cancer, for example, schedule an appointment at a cancer center.

If that expertise is far away, consider using a remote second opinion service, says Leah Witt, M.D., a geriatrician and pulmonologist at UCSF Health in San Francisco, which provides an online second opinion program.

You send the relevant medical records, and the service gives you an opinion, Dr. Witt explains. Cleveland Clinic, Stanford Medicine, Johns Hopkins Medicine, and Dana-Farber Cancer Institute all offer similar programs. The downside? They’re often not covered by insurance.

If possible, find someone who’s also an expert in geriatrics. Seeing a cancer specialist is good, but a geriatric cancer specialist may be better.

“I take my children to a pediatrician,” says Dr. Hashmi. “Why? Because their physiology is different. The medication doses are different. The entire approach is different.”

Same goes for geriatricians. Their approach will be tailored to your current stage of life.

If you want a second opinion about surgery, seeing a geriatrician is smart for a few reasons, says Dr. Hashmi.

First, a geriatrician may be able to more accurately assess potential risks and recovery time based on your age and health. That may change your mind about having the surgery, or make you feel more confident and informed going in.

Second, if you decide to go ahead with the surgery, a geriatrician can help you prepare both physically and mentally.

You’re also wise to seek out a geriatric pharmacist, who can look at the medications you’re on, and advise you on any potentially harmful interactions with the anesthesia.

Step #4: Schedule Your Appointment

Two important things to cover during this call:

• Make it clear that you’re seeking a second opinion, and explain your situation in your own words. Be specific, but don’t use medical jargon, especially if you’re not quite sure what it means.
• Ask what’s the best way to deliver your medical records, and when you should send them. Then take it one step further and ask, “What information will you need?”

Send exactly what they ask for, says Dr. Hashmi. Not more.

“The doctor’s office will tell you, ‘Send us one year’s worth’ or ‘the past six months’ worth,” Dr. Hashmi says. “Whatever it is, send that. The more focused you can be, the faster you can get to the bottom of your question.”

One thing to always include: the most recent note from your primary care doctor. It will likely provide much of the relevant info to date.

Ask your primary care doctor for a “clinical summary,” and use that specific phrase, says Dr. Hashmi.

If you’re paying out of pocket and wondering about cost, you can ask the receptionist about that too.

Step #5: Double-Check Your Medical Records

Yes, you should call the day before your appointment to confirm your records were received. But it’s also a good idea to bring your own copy of your medical records with you to the appointment, says Dr. Mancuso.

“A lot of times patients say, ‘You have that information. It’s in the chart,’” says Dr. Mancuso. “Well, it should be in the chart.” But not always.

You’ll likely have to sign a release form allowing your first doctor to share your records. And when you do, ask for your own copy. By law, your doctor cannot refuse this request, Dr. Mancuso says.

And don’t forget to gather your family medical history. Family history ups your risk of lots of conditions. Talk to family members, starting with parents, siblings, and children.

Missing information is one of the biggest problems doctors run into with second opinions, says Dr. Witt. Without the proper information, “I feel I can’t offer a good second opinion. And things are delayed.”

Even though your doctors are providing the medical opinions, you play a vital role. “A patient can be the most important member of the physician team,” continues Dr. Witt. “If you come prepared, then we can turn our mental energy away from gathering the data to really synthesizing the data and figuring out where to go from there.”

Step #6: Make a List of Your Questions

If you’re going to research your condition online (and let’s be honest, you are), make sure you do so with a “huge truckload of salt,” says Dr. Hashmi. In general, look for websites that end in “.org” (like my.clevelandclinic.org or mayoclinic.org) or “.gov” (like cdc.gov or nia.nih.gov).

A helpful tip: In the search bar, type “national guidelines for” and then your condition. Then look for the sites that end in “.org.” Most conditions have an organization associated with them, says Dr. Hashmi, and this is one way to find it.

If you’re researching a very rare condition or procedure, then researching online won’t be enough, says Dr. Mancuso. Ask your primary care doctor to reach out to specialists and help guide you.

Whatever you do, don’t get sucked into message boards, which can be alarmist, says Dr. Witt. And by the way, don’t be afraid to share Dr. Google’s findings at your appointment.

“A lot of people don’t bring that up because they feel they’ll insult us,” says Dr. Hashmi. But wait for the middle of the appointment so the doctor doesn’t jump to conclusions. If partway through the visit, the diagnosis or treatment you’re wondering about hasn’t come up, say, “I was doing some research and wondering about X.”

Questions? Write them down. And remember, you can recruit your primary care doctor to help you brainstorm.

Some good ones to get you started:

• What are the expected benefits of the recommended treatment?
• What are the likely downsides?
• How many patients benefit, and how many don’t?
• Are there any alternative treatments that are less invasive?

Step #7: State Your Goals Very Clearly

Are you looking to live longer? Improve your quality of life? Perform a specific activity?

Whatever your goals, be sure to state them very clearly so your doctor can recommend the treatment option that aligns best.

Knee replacement surgery, for example, includes many treatment options, says Dr. Mancuso. “Do you want a knee replacement that lasts 20 years but won’t allow you to be as mobile?” he says. “Or do you want a procedure that will last five to 10 years but allow you to be more mobile?”

Too often, patients don’t express their main desire and can become frustrated when the treatment outcome does not match their expectation, adds Dr. Hashmi.

If you get two different opinions, go with the one that’s more closely aligned with your goals. Talk to your family members and the people who know you best.

What If You Get Two Different Diagnoses?

One out of every five patients who seek a second opinion receive a completely different diagnosis, according to a recent study in the Journal of Evaluation in Clinical Practice. If that happens to you, here’s your plan.

First, ask the two doctors to get together and try to reach a consensus. Often in a specialized field, doctors know each other and are happy to hop on a call with a colleague, Dr. Hashmi notes.

If that doesn’t work, seeking a third opinion may be appropriate. Again, you’ll want to check your coverage, costs, and any rules. Medicare Part B covers a third opinion for medically necessary surgeries that aren’t an emergency if the first two opinions disagree. If you have a Medicare Plan or other insurance, check with them directly.

Ultimately, decisions about your health care are up to you. As long as the reasons behind each treatment are well explained and you feel confident that you understand the options, you’re in a good position to make the right call.

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