How to Get a Second Opinion

Question: Hello Dr. Costrini my name is Margaret. I am 56 years old and live in Pooler. For years, I have suffered from headaches, chest pains, periodic indigestion, numbness of my hands and feet, fleeting low abdominal and pelvic pain, and have now developed an odd rash on my torso. I have been seeing my primary care physician for several years, and on occasion he has referred me to different specialists for evaluation of certain complaints. I am not well and I do not seem to be getting any better. I have been advised by my family to look for a second opinion. What do you think I should do?

Answer: Margaret, your situation is not uncommon and I appreciate the question. There are various reasons why patients seek another opinion regarding their illness. When no diagnosis has been given to you for your aches or pains or other symptoms, it is reasonable to seek advice from another physician in order to provide a substantive diagnosis. Without a specific diagnosis it can be difficult to provide an organized treatment plan. In some cases, the patients may have no diagnosis and indeed symptoms may be getting worse. There may be a sense of urgency that could also stimulate consideration for another opinion. Other patients may have a known diagnosis, but the patient may be uncomfortable with the treatment plan or in some cases the treatment may be already in progress, but may not be effective. This is a very common situation in patients who have advanced specific disorders such as cancer or heart and lung disease. Another reason why patients may seek a second opinion is in fact simply because they do not like their doctor. More specifically the doctor-patient relationship is not strong, secure, and does not evoke confidence.

From the above, the first important decision a patient must make when considering a second opinion, is to determine with honesty, exactly why they want another physician to participate in their care. In a case where there is no specific diagnosis provided, it is important to work with your physician and ask the specific question What is my diagnosis? At times, a physician may step over such specific data and spend office time dealing with symptoms and with measures to improve how the patient feels. You may derive significant relief if the physician can answer your question. Often times they can. This would not be an uncommon situation in a patient who has perhaps recurrent headaches. They may be tension headaches, they may be migraine headaches, etc., but the physician may not have given the patient a specific diagnosis. In this regard, when there is no stated diagnosis, both the doctor and the patient need to discuss the reason for the absence of this data. Often times, the patient and a doctor may have had a long-standing relationship and there is no sense of urgency. The doctor manages the complaints because the doctor is satisfied with the status of his patient.. The patient may have to raise the level of concern and in a secure doctor-patient relationship the doctor may agree to order more tests, although he may indeed feel there may be only limited necessity for doing them. The doctor may have a lower sense of urgency. The doctor may be concerned about limiting cost when he is comfortable with the patients stability regarding their illnesses. The patient however may have an entirely different perspective based on having to live day-to-day with complaints, anxiety regarding potentially misdiagnosis and a new sense of urgency that may arise for reasons unrelated to the patient. This is frequently the case when a family member may develop a serious illness. The patient as a family member may have a heightened new sense of concern for his/her own health. When a diagnosis is made and a treatment plan is given, there may be several reasons why treatment is not working. It may in cases of patients with diabetes require attention to diet, medications, and lifestyle to better control blood sugars. Working with a physician to identify known and unknown factors, which are limiting the success of a correct treatment program may be all that is necessary. In cases where a treatment plan is offered such as a program for managing cancer or other serious illnesses, obtaining a second opinion before treatment has started, is not unreasonable. In this regard, it is important to confer with your physician as in most cases the physician is an ally of the patient even when a second opinion is sought. It is far better to work with your principal physician in order to obtain a second opinion because that physician may confer directly with another specialist and provide more specific information, and also state your specific concerns. In this regard, it is always helpful to obtain a copy of your health records and to keep them in your possession. Because of the uncertainty of transfer of medical records you can facilitate a second opinion by having the records with you when you visit another physician. When you attempt obtaining a second opinion on your own, you can run into difficulties. Opening up the phone book, finding the list of primary care physicians, neurologists, orthopedic surgeons, chest surgeons, cardiologists, etc, without the opinion or input of a concerned physician may lead you down a path of additional testing and for no net benefit for your principal objective of improving your health and well being. In conclusion, obtaining a second opinion should be considered an extension of a strong doctor-patient relationship. Once the second opinion has been obtained, if you preserve the doctor-patient relationship and have been reassured that the treatment program is correct, that the diagnosis is proper, and no diagnosis has been overlooked with reasonable certainty, you can return to the care of your principal physician and continue under that doctors care with a heightened degree of confidence. The vast majority of physicians are comfortable in negotiating second opinions on behalf of their patients. If your physician is reluctant, not supportive, and indeed disagreeable, then it is likely that you did not have a strong doctor-patient relationship to begin with and you are actually not seeking just a second opinion, but actually are looking to change doctors. That is an important decision that you must make, and it is certainly not without merit. I hope you find this information helpful, and I wish you good fortune in finding answers to your concerns. Dr. Nicholas Costrini writes regularly for the Savannah Morning News. His articles occur every other week in the close-up section. He may be contacted at ncostrini@georgiagi.com.

The Savannah Morning News "Good for What Ails You" and Dr. Nicholas V. Costrini would appreciate hearing favorable comments. Please call: 912.652.0370 Vox Populi