Breaking Down the Barriers to a Second Opinion

When patients receive life-altering diagnoses, face aggressive treatments, or have misgivings about a provider’s conclusions, they may wonder if they should seek a second opinion. A recent study by Mayo Clinic researchers suggests that patients who do get second opinions frequently end up with different diagnoses. Of 286 cases referred by primary care practices to specialists, 21 percent resulted in distinctly different diagnoses. In 66 percent of the cases, the diagnoses were better defined or refined. Yet, many patients may be reluctant to ask for another physician to review their cases. In this guest post, Charlene Rothkopf, a founding members of the Johns Hopkins Hospital Patient and Family Advisory Council, reflected on her personal experience pursuing a second opinion, examines some of the reasons that impede others from doing so, and suggests how physicians might help remove the barriers.

Last year, I was being treated by a physician who, based on some blood test results, wanted to radically increase my medication after several months of weaning me off. I was hesitant because of the adverse side effects of the medication, and I was beginning to feel relief with the reduced dosage. I asked about getting a second opinion and could sense that the physician did not appreciate his judgment being questioned. He gave me the names of a couple other physicians, but I decided to seek the opinion of a different doctor on my own. After a review of my records, medical history, and a thorough examination, the new physician said that I didn't need to increase the medication and, in fact, I could continue to reduce the dosage. After sharing this second opinion with my original physician, he responded, "Well, there can only be one captain of this ship!" I never went back, and I began seeing the new physician for my continued treatment. Today I am fully recovered.

Was this experience unusual?  I began to ask other patients if they hesitate to ask a doctor for a second opinion and, if so, why.

• "I don't want the doctor to think that I don't trust him/her. I don't want the doctor to think that I'm challenging his/her judgment." Patients put their faith and trust in their health care providers and don't want to question their credibility or authority. Asking for a second opinion might be interpreted as a loss of confidence in the physician.
• "I don't want to be perceived as a difficult patient or appear rude." Patients want the doctor to feel good about them and don't want to potentially damage the relationship. If they are about to undergo surgery, for example, patients want to make sure that the doctor "likes" them and will take special care of them throughout the entire process.
• "My doctor's office is so busy. There are so many patients waiting to see him/her and there is so little time for me as it is. If I ask to have all my records sent, it's just creating extra work for the entire staff." Again, some patients don't want to seem difficult and are reluctant to ask for anything that might be perceived as an unnecessary inconvenience to the physician or the staff.
• "I'm embarrassed to tell the physician that I may not be able to afford it. Also, English is not my native language and I don't completely understand what he's saying. I probably should have seen a physician who can explain things to me in my own language." Patients may withhold personal information out of a feeling of confusion or embarrassment.
• "He/she is just going to give me the name of a friend or colleague. The second physician won't want to throw my doctor under the bus." Patients may not know whom to contact and may believe that a second physician will not contradict his/her colleague out of respect or professional courtesy.
• "I know that there is no hope for a different outcome, so it would be a waste of time. Besides, I don't have the time to travel far to get another opinion." After a severe diagnosis from a physician, some patients are understandably sad and despondent. They may feel a sense of futility in seeking another solution to their health problem. They may also feel pressured by a sense of urgency to begin treatment and choose to forego other options.

So, what can a health care provider do to help patients be more comfortable asking for a second opinion? Here’s my wish list:

• Engage the patient. Explain the treatment plan as clearly and understandably as possible and then discuss it with the patient — and family member(s) — to uncover any concerns. Patients have the right to fully understand what their treatment entails and what options are possible. Ask, "What questions or concerns do you have about this plan?" If you sense that they may be holding back or reluctant to say what's on their mind, state that you truly want them to be honest and to feel free to share any worries. Offer to let them think it over, and schedule a follow-up call or visit to review the alternatives further.
• Reach out to other physicians. Confer with other specialists, particularly if it is a difficult or sensitive case. Share with the patient that the treatment plan was discussed with others before providing the recommendation.
• Encourage obtaining a second opinion. Discuss the value of a second opinion, especially in the case of major surgery or a severe diagnosis. Patients should seek peace of mind and feel confident that they've explored all possible options. Express that it would be fine if they want to get a second opinion: "I would be happy to suggest a couple other providers — outside of this group practice — that you might contact, and we'd be happy to forward a copy of your medical records." Offer to speak with the other physician(s) if needed.
• Be open to other perspectives. If the second opinion is different, be open to hearing the patient's perspective. Perhaps suggest a third opinion. Shared decision-making is key to determining the right answer for the patient.

While I recognize that most physicians are very supportive of their patients seeking second opinions, there still may be intangible, and often emotional, reasons why patients are reluctant to ask for one. My hope is that health care providers will take the time to talk with their patients and listen to their concerns, particularly if there is reticence or discomfort in pursuing the proposed plan of treatment.

This post originally appeared on the Window into Wellness blog.