When to Get a Second Opinion
Double-checking a medical diagnosis just might save your life
Several months ago, actress Rita Wilson (wife of Tom Hanks) decided to get a second opinion even though two breast biopsies came back normal. For years, Wilson had closely monitored her LCIS (lobular carcinoma in situ) — which didn’t require treatment — through annual mammograms and MRIs.
But on the advice of a friend, she decided to see another doctor, and was happy she did. On a second look by a different pathologist, the diagnosis was invasive lobular carcinoma, a stealthy and dangerous form of ductal cancer that is often found with another condition Wilson had, pleomorphic lobular carcinoma in situ (PLCIS).
Today, Wilson credits a second opinion with saving her life; she ended up having a double mastectomy followed by breast reconstruction.
“I share this to educate others that a second opinion is critical to your health,” Wilson told People. “You have nothing to lose if both opinions match up for the good, and everything to gain if something that was missed is found, which does happen.”
How Do You Know?
But Wilson's situation is one that extends to all health issues for men and women and begs the question: When should you get a second opinion?
The answer: More often than you may think.
As it turns out, it can be very common for doctors to disagree. A recent study out of Seattle, Wash., found that pathologists across the U.S. looking at breast biopsies matched a panel of experts only 75 percent of the time. While the pathologists and the expert panel were most likely to agree on biopsies that were invasive cancer, they were less likely to agree on benign lesions or abnormal cells that hadn’t spread or invaded other tissues. That means that in these more ambiguous medical situations, a second opinion was warranted.
It’s also not unusual for a diagnosis to be wrong.
In a Johns Hopkins study of 6,000 cancer patients several years ago, researchers found that one to two of every 100 patients who sought a second opinion after a tumor biopsy had received an incorrect diagnosis.
Worry and More Worry
That said, should we run for a second opinion every time a doctor finds something? Is it not crazy-making to second-guess ourselves or our doctors? Even worse, if a doctor gives you a good report should you seek a second opinion to double-check that you’re OK? Or is that — you should excuse the expression — overkill?
Trisha Torrey, founder of the Alliance of Professional Health Advocates (APHA) and author of You Bet Your Life!: The 10 Mistakes Every Patient Makes, was diagnosed with lymphoma in 2004 and told she had three months to live after finding a growth on her torso. But Torrey didn’t think the diagnosis matched how she was feeling, so she sought a second opinion, and learned that she was fine.
As it turned out, the first pathology report had been interpreted incorrectly by a zealous medical student, which is not uncommon at large teaching hospitals. “You have a better understanding of your body than anyone else,” Torrey says.
When to Get a Second Opinion
Here are some instances when a second opinion may be warranted:
- If the treatment your doctor recommends or your illness is at all invasive, especially difficult (chemotherapy or radiation) or likely to be chronic
- If surgery is required
- If it’s a condition that is inherently tricky to diagnose but very symptomatic, such as Lyme disease or chronic fatigue syndrome
- If there are many treatment options for what you have and you want to figure out the best course to follow
- If a treatment is experimental or you’re considering participating in a medical trial
And if the way you’re feeling — for better or worse — doesn’t match your doctor’s diagnosis, you should also get a second opinion. That was the red flag for Torrey, who could not reconcile her terminal diagnosis with how good she felt, especially out on the golf course. She just didn’t feel like she was dying.
Similarly, if your doctor is telling you everything is fine but in your heart you’re not feeling right, it’s time for a second opinion.
“If you have discomfort or appetite changes or you are in pain from something, you know there’s been a change to your body, then pursue answers until you get one that makes sense,” Torrey says.
In cancer patients, a second opinion may save lives, and it has been shown to change treatment choices.
A University of Michigan study of breast cancer patients found that half changed their course of treatment when they got a second opinion. Variations in diagnosis, such as the stage of a particular kind of cancer, influence a patient’s decision of how aggressive to be in treatment.
However — and this is where it gets confusing — don’t assume a second opinion is always right. If you see a second doctor and his or her opinion is very different from the first, it may be wise to get a third opinion as a sort of tie-breaker.
And sometimes, advises Torrey, it’s best to go back to the first doctor, present what you’ve found and raise questions.
Your Own Best Advocate
As your own best health advocate, never be embarrassed about telling your doctor you want to get a second opinion. Many doctors in fields such as neurology and oncology will appreciate another doctor’s view and confirmation of their diagnosis or treatment plan. From a liability standpoint, a second opinion is an extra safeguard against a lawsuit for a doctor.
“We all want to be polite and civil and don’t want to spark an adversarial relationship (with our doctor),” Dr. Jerome Groopman, co-author of Your Medical Mind: How to Decide What Is Right for You, told WebMD. “Yet, I feel strongly that any time a patient raises the issue of a second opinion, a physician should welcome and endorse it.”
If your doctor is angry or upset that you’re getting a second opinion, Torrey’s advice is as straightforward as, well, a conclusive diagnosis: run for the door and never look back. There are plenty of excellent doctors out there.