When your patient wants a second opinion: Considerations for HCPs

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published January 30, 2024

Key Takeaways

  • Patients have a right to a second opinion. While they lead to changes in management in a substantial number of cases, they also boost patient satisfaction and comfort.

  • Physicians should encourage their patients with serious illness to secure a second opinion to explore all available treatment options.

Although it may feel off-putting when your patient asks for a second opinion—almost as if they don’t trust the first opinion you gave them—second opinions are completely acceptable. Patients have a right to a second opinion, and they are especially useful in non-emergency presentations. 

Why a second opinion?

Many experts recommend that formal processes for second opinions be established within the healthcare system, but they are currently rare. Processes could include programs that direct patients to specific specialists and help them reconcile any discrepancies in opinions regarding care, meaning the onus wouldn’t be on patients exclusively. 

Experts recommend that physicians encourage their patients to seek a second opinion, and up to 88% of patients desire a second opinion. They may be interested in a second opinion due to doubts about diagnosis/treatment, interest in what a sub-specialist has to say, and dissatisfaction with the first opinion.

Interestingly enough, as many as 56% of patients have reported a difference between first and second opinions, with 91% of those patients preferring the first opinion.[]

Per the results of various systematic reviews, in 43%–82% of cases, the second opinion confirmed the first one. Furthermore, in up to 69% of cases, there was a change in diagnosis, treatment, or prognosis. Other findings indicate that there was a moderate/major change in 21% of cases with regard to diagnosis, and in 31% of cases for treatment. Overall, the vast majority of patients (95%) were pleased with receiving a second opinion.

“In summary, the main finding of these surveys was that a second opinion disagreed with the first one in a substantial proportion of patients,” according to the author of an editorial published in the Israel Journal of Health Policy Research. “The main limitation of these surveys is the absence of a gold standard that would identify ‘correct’ opinions. Still, it is widely agreed that patients have a right to an independent second opinion and, in case of divergent opinions, to deliberate and choose the option that they believe is most consistent with their individual preferences.

Challenges to a second opinion

Patients of lower socioeconomic status, the editorial’s author states, are less likely to obtain a second opinion, possibly because physicians are more inclined  to advise younger and better educated patients to take this step. This finding suggests that healthcare inequities abound.

In addition, physicians may be biased against the elderly and the poor. Second opinions in such patients, however, may be especially useful, because uneducated and older patients are more susceptible to disease, and any sign or symptom of disease may represent a more severe condition.

“Hopefully, doctors’ awareness that poverty, lower education and old age are risk indicators for disease will reduce their subconscious discrimination against such patients,” wrote the author.

Another challenge to receiving a second opinion is that the process is time consuming for patients and healthcare staff.[]

Considerations for care

Physicians should keep in mind that patient advocates encourage patients to receive a second opinion to further explore treatment options and adverse effects of treatment. The act of receiving a second opinion further empowers patients.

“A good doctor will understand that you will want to seek a second opinion and will encourage you to do so in order for you to feel comfortable and assured before starting treatment. Keep in mind that they would likely do so if they were in your position as a patient,” per the Patient Advocate Foundation (PAF).[]

Physicians can explain the reasons for getting a second opinion to their patient, which could include the possibility of a different approach or treatment plan. To stay in the loop, physicians should encourage their patients to inform them of the results of a second opinion, as well as their final decisions.

The AMA is also on board with physicians encouraging their patients to receive a second opinion.

“Assure the patient that he or she may seek a second opinion or choose someone else to provide a recommended consultation or service. Physicians should urge patients to familiarize themselves with any restrictions associated with their individual health plan that may bear on their decision, such as additional out-of-pocket costs to the patient for referrals or care outside a designated panel of providers,”states the AMA Code of Medical Ethics.[]

What this means for you

It’s understandable to feel defensive when a patient asks for a second opinion. However, for the patient’s well-being, comfort, and empowerment, it may be a good idea to encourage them to seek a second opinion. If your patient asks for a second opinion, you can foster a healthy doctor-patient relationship by checking on payor coverage and what out-of-pocket costs the patient may incur. As well, be sure to ask your patient to keep you in the loop regarding final decision-making.

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