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What does a patient do when faced with a decision that is uncomfortable, a choice that is difficult or feeling a sense of lacking information? It’s a familiar position of hesitancy to proceed.  I would say that every patient deserves a clear understanding of their medical situation and a high level of confidence on the course they are following to manage their conditions. If a patient ever considers they may need a second opinion, heed that inner voice and seek options for a second opinion.

If the diagnosis is already certain, a specific specialty will be clearly identified and the logistics in getting a second opinion will be on a more defined path. Certain centers are well-known for expertise in particular areas. It is more common for patients to seek second opinions in cancer care or to determine if a major surgery should be pursued. The more difficult situation is when a diagnosis has not been found and the patient is still searching for answers to unexplained symptoms. At this stage, the patient is often with their primary care doctor and perhaps having multiple specialists each evaluating the clinical picture in turn. It is not unusual to seek a second opinion from another generalist in Internal Medicine, Family Medicine or Pediatrics.

Asking the primary care physician to refer for a second opinion often feels uncomfortable. It should not be. Open communication goes a long way to making all relationships better. The referral also offers a more cohesive way to share records and test results. Fresh eyes on symptoms and signs and even a different approach to history taking and problem solving often improve patients’ confidence that their story is being heard and processed. The devil is in the details and there’s a lot of legwork in getting all the medical records assembled. There are multiple virtual options to get second opinions in the online age. A quick google search will provide an array of choices. The telemedicine route may not be the way to go if you require physical examination or multiple appointments with additional testing. Depending on the nature of the issues or the diagnosis, the primary care physician may know the best source of a second opinion.

Best practices for patients seeking a second opinion:

1.       Ask your primary care physician for a referral to receive a second opinion.

2.       Assemble the names and contact information for all the specialists that have medical records on your care related to the issues of concern. Include phone and facsimile numbers in addition to addresses.

3.       If physician practices have closed or providers have retired, consider requesting key test results from imaging centers directly or looking for operative reports through the hospital where a surgery was performed. Blood test results are also important diagnostic information.

4.       Prepare a written narrative of your symptoms, findings and progress of illness so you do not forget important information you wish to convey.  Accurate and complete past medical and surgical history and biological family history could be relevant and it’s often best to create a comprehensive list and always have it handy.

5.       Construct an up-to-date list of all your medications, including over-the-counter products, creams, inhalers, herbal supplements and vitamins. Also list any previously tried medications and problems experienced with them or note if ineffective for intended purpose.

6.       Be open minded as you engage with the second opinion. Avoid conveying frustration or dissatisfaction with prior physicians and focus on the areas of health concern.

The medical community is your partner in care and is always an available resource to discuss any gaps in understanding and other unmet needs. Second opinions may serve a role on this path. Patients are supported to be proactive advocates for their health and well-being and should have every confidence in their care plans.Kavita Sharda Persaud, MD is a graduate of Queens University of Belfast Medical School.  She completed her Residency in Internal Medicine and a Fellowship in Geriatric Medicine at State University of New York at Buffalo.  Dr. Persaud’s practice is Carolina Geriatrics in Wilmington, North Carolina.  She is 2021 President of New Hanover-Pender County Medical Society.