Chapter 11: Get a Second Opinion. Get a Second Opinion. Get a Second Opinion.
The What, Why, When, How, and How Much of Second Opinions.
My family always had a rule about surgery. Unless it’s a life or death emergency, always get a second opinion. Sometimes a third. Couple of times a fourth.
One summer, when I was a preteen, I had injured my coccyx bone from a double whammy of growing too fast and riding horses multiple times a day. The bone, supposed to look like a smooth open letter C, had turned into a rough copy of a W.
Every so often, I experienced random acts of paralysis followed immediately by sharp shooting pains up my back. I was paralyzed from the waist down, stuck in place. The one-two punch might happen after sitting at the kitchen table for lunch or in the classroom for an hour or at the movies. I feared I would be stuck in place forever. For a kid with undiagnosed ADHD, lovingly called ants-in-her-pants, this was a nightmare scenario.
The shooting pains ricocheted through my spine, my arms would jerk violently and involuntarily. Once I knocked over the heavy kitchen table, turning the linoleum floor into a mine field of glass and china shards accompanied by silverware and leftovers in milk puddles. On the poorly designed pain scale of 1 through 10, that was a 36. Sometimes these events would last 5 minutes. The longest took almost two hours to subside; that one haunted my sleep for years.
The first doctor told my parents that I needed spinal surgery immediately to avoid permanent paralysis. When my mom asked what were the risks, he answered I had 50-50 chance of walking after the surgery.
The second doctor seemed unconcerned. He called it growing pains and said I would grow out of it.
The third doctor agreed I needed surgery but thought ice and rest might be the better solution. He suggested watchful waiting unless the episodes increased.
The fourth doctor showed us a diagram of what he thought was happening. He suggested a rigorous physical therapy program to protect the coccyx bone by strengthening the muscles surrounding it.
Four different opinions. Which would you have chosen? And why? [See below for what we chose.]
Why are second opinions important?
Misdiagnosis and medical error are common. A second opinion can confirm that the diagnosis is correct and that the treatment is the best option. Sometimes, all you need is peace of mind. Ask for a second opinion if you feel unsure, uncomfortable, or want more information. I highly recommend everyone seek a second opinion in these situations:
Serious or complex diagnoses: Don’t accept the first doctor’s word if your life or lifestyle is on the line. If you’re diagnosed with cancer or a neurological disease (like ALS, Parkinson’s, Multiple Sclerosis (MS), or Alzheimer’s), see the most experienced expert you can find. They will review the initial test results and consult on the best approach.
Major treatment decisions: Never agree to any surgery before getting a fresh set of eyes on the diagnosis and treatment plan. Every surgery has risks, even oral surgery. If your doctor suggests an invasive procedure or a long-term medication that may have side effects, you want a second expert to go over it with you, ideally one unconnected to the first doctor’s practice.
Unclear, Dismissed or Ignored: If you can’t get a diagnosis, if you believe the first doctor is missing key details, or different types of specialists suggest different diagnoses or treatments, a second (or third) opinion might clear up the confusion.
No way out: If you’re told your options for a cure or a treatment are limited or the doctor is pushing experimental therapies, another point-of-view may help you find new approaches or feel more confident in the choices you have.
Peace of mind: Much of the healing process is psychological. Feeling confident in the choices you make, the diagnosis you accept, the treatments you follow can help you feel better faster. This is especially true if the diagnosis or treatment –– including surgery –– will greatly impact your life or lifestyle.
The whole point is to help you make a well-informed decision that works
with your health goals and values.
What are the barriers to getting a second opinion and how to overcome them?
The most common issues are financial, access, and emotional:
Cost and insurance limitations. Check with your insurance provider. Most of the big insurance companies, and Medicare and Medicaid, encourage you to get a second opinion, especially before surgery and expensive or invasive treatments. Medicare requires you choose another doctor who accepts Medicare. Medicaid rules vary widely on a state-by-state basis. If cost is a factor, explore local clinics, your nearest Federally Qualified Health Care (FQHC) organization or programs offering affordable or free second opinions.
Limited local access to specialists or expertise. If you live in a medical desert with few specialists nearby or your region is dominated by one major health system making an independent second opinion difficult to get, there are several world-class healthcare organizations who offer remote or virtual second opinions without requiring a physical exam. Don’t forget to gather all your medical records before reaching out to a remote service so you can upload them or mail them.
Here are a few with costs, if available:Stanford Medicine Online Second Opinion serves both adults and children. Cost: $700
Cleveland Clinic’s Virtual Second Opinion services uses an online portal to match you with the appropriate specialist. Cost: $1,690-1,990
Johns Hopkins Medicine’s Second Opinion services focus on rare or complex diseases. Use their search button because it’s not offered by every specialty. Type in “remote second opinion” plus the specific medical condition for how to schedule it.
Memorial Sloane Kettering Cancer Center offers remote second opinions, even if you suspect you have cancer but haven’t been diagnosed yet. Call 844-298-6212 24 hours a day, 7 days a week. Or visit their online appointment portal and write you are requesting a remote second opinion.
Teladoc Health offers many telehealth services, include second opinions.
Time constraints and scheduling difficulties. This is a common issue. As discussed in Chapter 6: Hunting The Elusive Top Specialist And Surgeon, even in rich medical markets, you can wait a long time to see a specialist for a second opinion. Let the scheduler know you’re requesting a second opinion. Also, say if it’s highly time sensitive because it’s a life threatening diagnosis or if your specialist is pressuring you to make a decision sooner.
Fear of challenging the primary doctor or causing conflict. A physician friend recently told me that if any doctor argues that you don’t need a second opinion, run. Good doctors care about their patients more than their egos. If you’re nervous or fearful about having this conversation with your doctor, ask a friend or family member to come with you. Or, do like I do, just get the second opinion and choose which doctor, diagnosis, or treatment offers you a greater sense of confidence.
Unless it’s a life or death emergency, always get a second opinion before surgery.
How do I choose?
Ask each doctor to explain why they believe what they’re recommending is accurate. After you hear their thoughts, share what the other doctor suggested and ask what they think. Ask about the risks each treatment may create. Listen carefully and trust your gut. Consider your personal values, quality of life, and comfort with each option. Also, check out patient advocacy groups related to your condition. They’re a reputable source of information on the pros and cons of every relevant treatment.
What if both the original doctor and the second opinion doctor disagree?
They often will. You have four choices:
Pick the option that makes the most sense to you and try the suggested treatment plan.
Get a third opinion. Sometimes, get a fourth.
Request a Multidisciplinary Consultation. That’s when a team of different specialists at one healthcare system review your case together. Not every medical condition can get this option but it’s available for complex or life-and-death diagnoses. It’s even available remotely. Don’t forget to check that the institution is included in your insurance company’s network.
If you still can’t decide –– and no decision is still a decision to delay care –– hire a patient advocate to help you navigate this process. Ask your insurance company or hospital to recommend someone local. Or check out this nonprofit rated highly by Charity Navigator: Patient Advocate Foundation,
The whole point is to help you make a well-informed decision that works with your health goals and values.
So, what did my mother decide? She chose doctor #4’s plan: a rigorous physical therapy program to protect the coccyx bone by strengthening the muscles surrounding it. It was the least invasive and the least risky. Best part? It worked!
Next Up: Chapter 12: Why It’s Good When Doctors Can Say “I Don’t Know.” Uncertainty is the Opposite of Dismissal
© Helene M. Epstein 2025
I would suggest that people should understand that the most successful docs are those with the most survivors. The good docs WANT their patients to do well ---not only because they care about their patients, but also because their practice thrives with more stories of survivors.
This all just makes business sense.
Thanks, Helene. This will of course all become more difficult when Medicaid is gutted.