Just as you would likely review multiple cars or houses before making a final choice, there are moments in healthcare to find another resource for your medical issues. Second opinions in medicine are more common than you think—once we’re done with this pod, you’ll be able to request for the right kind of additional expertise on time and on target.

Even if you’ve seen the same doctors for long enough that both your and their hair are turning gray, you can and should be comfortable asking for a second opinion in a variety of situations. Not every doctor is going to make a clear diagnosis like how Google autocompletes your search bar. You might think of getting another doctor’s advice with a complicated surgery or cancer. For any given condition, you may need to stick with a given care team for a while during the best possible treatment. The most appropriate times to seek a second opinion besides in a cancer or surgery context are when you don’t like your providers, you want another specialist to contribute to your care, you wish to review other treatment options, your diagnosis is rare, or if your first-choice doctors have no straightforward approach for handling your condition. However, there are limits: if you’re bleeding more than a tech company’s stock price you probably don’t have the luxury to wait for another doctor to say you’re in trouble. There also few good reasons to get a seventh or eighth opinion for an issue—a handful of assessments is better than too many or just one.

The Mayo Clinic ran a study long ago on second opinions handled by their own internal medicine doctors to see how diagnosis changes would occur. Based on referrals during 2009 to 2011 from primary doctors outside the Mayo Clinic system, researchers compared initial diagnoses from a referring provider with their own staffs’ opinions. Only 12% of diagnoses for the patient sample size were confirmed and consistent with the initial assessment. The diagnosis fully changed for 21% of cases and the next ~67% of cases had some refinements or adjustments. That disparity of medical opinion, even back then, is nuts. This study among the other sources in this pod are linked on my Substack post at rushinagalla.substack.com.

Let’s use dermatology for a simple example. Suppose that you spend a lot of time in the sun and one day you’re worried about a spot on your arm that’s been changing colors and size over the past several months. You see dermatologist A for an exam to go over your history. That doctor might say he or she isn’t 100% sure what the spot is among a few possible diagnoses but that it’s worth your time to monitor that spot month-to-month. You might be rather uncomfortable with that outlook because you’re worried about skin cancer and on top of that, scared of needles with regard to having the spot surgically removed and tested. Hence in this case where the clinical diagnosis is unclear and surgery is off the table, you may go to dermatologist B in the next town over for another take. Both dermatologist A and B could be skin cancer experts and have gone to the same medical school but the demographic of patients that derm A sees may contrast with derm B’s patients. One of those doctors may also have several thousand more procedures under their belt due to how a practice is organized. Of course, there might be other history that matters for making the correct diagnosis, but in the realm of medicine in general, besides dermatology, many diseases share common symptoms. By that guideline alone, it’s wise to seek another provider for input when there isn’t any clear-cut answer or treatment. A given field of medicine also can advance so fast that sometimes another provider keeping up with the newest clinical science may have their own take on helping you.

Most doctors should feel comfortable with you getting another opinion. In some cases the doctors may initiate the process themselves for getting you referred to a specific provider with the right expertise for your condition. In this context normal referral guidelines apply like I talked about back in Episode #7. Most the time, however, you will need to be in charge of asking for a second opinion. Advocate for yourself without insulting your doctor’s skills. That’s a fine line, but Yale’s medical school and the American Cancer Society’s resources offer some great prompts for patients to plant the seed of a second opinion. When consulting with your first-choice doctors, you can ask them to consider what they would do in your shoes. You may ask, “if you were in my situation, which colleague of yours would you seek for more advice?” You could also state that you owe it to yourself and family to make sure all possible options are covered. From a medical perspective in particular, you may also want to ask what other treatment or surgical choices exist, which is a solid transition into requesting an official second opinion. As long as you are polite but firm, you will get enough buy-in from your first doctor that any process to get your important chart notes, labs, and procedure history sent to the next doctor will be easier. In any case, you as a patient have a legal right to a second opinion—some insurance plans may require a second opinion or independent evaluation before significant treatment.

When you make it to your second doctor, you should review all possible avenues and risks of treatment. In the case of surgery, ask the doctor what his or her procedure volume is per day and month. You want to have professionals doing 100 hip replacements a month rather than someone who performs a few dozen. No matter what complicated medical care you need, one subtle but critical matter for second opinions is to connect with a professional outside your current health system if possible. Major facilities like Scripps or the Cleveland Clinic hire enough doctors across specialties that getting another person’s advice is almost like sending you down the hall for your next class. For example, you see your oncologist at Mass General Hospital but you may benefit from a private oncologist with experience treating your specific condition. There may be some homework required for making sure the second doctor outside of the first doctor’s setup takes your insurance or is accessible to you, but the effort to get a clear, independent take on your condition is worth the effort.

Regardless of who you see for a second opinion, make sure to bring your recent chart notes, lab results, procedure history, medication list, and pertinent questions. You’ll get much more out the visit and the second (or third or fourth) provider will be in a better position to help you. Once you have a productive visit, ask the second opinion doctor to forward new test results and notes back to your main physician so everyone stays up to date with your care. You might believe that all this care is only possible if you have a great health plan or superb connections. That’s why next week’s pod is going to be about how patients with no (or straight-up awful) insurance and zero connections can best advocate for themselves to get routine care in our current medical system. Subscribe and stay tuned to Friendly Neighborhood Patient for clear, simple healthcare commentary. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com