When to Get a Second Medical Opinion
Questioning the doctor makes most parents nervous—but sometimes your child's health depends on it.
Once upon a time, parents got a second opinion only when their child was facing major surgery or when the doctor gave an unusual or extremely threatening diagnosis. Things have changed.
Today, even if you have complete confidence in your child's pediatrician, you may want a second opinion -- whether to confirm that surgery is really the best option, ascertain that there are no new medical advances your current doctor may not be aware of, or because your insurance company requires one before treatment can proceed.
What Exactly is a Second Opinion?
Getting a second opinion means consulting with two doctors for a diagnosis and recommendation regarding the same set of symptoms. In most cases, the original diagnosis will come from your pediatrician. If he's not certain what's causing your child's problem, thinks your child has a chronic or serious disease, or feels unable to treat your child, he will recommend a consultation with a specialist -- a doctor who specializes in the area of concern, whether it be an allergist, dermatologist, pediatric ophthalmologist, or pediatric urologist.
For example, following a series of strep throats, your doctor suggests that you have a specialist look at your son's throat: While the pediatrician has been able to treat the surface symptoms, she may suspect that there's an underlying problem that a specialist could diagnose. Perhaps your child needs tubes in his ear, something the pediatrician couldn't do herself. In this case, you would probably consult with a pediatric otolaryngologist, or ENT -- a doctor who specializes in disorders of the ear, nose, and throat.
Taking Matters into Your Own Hands
Sometimes parents will get a second opinion on their own; this is called self-referral. Say, for example, your 1-year-old has frequent reflux (when the contents of the stomach are forced upwards into the esophagus). You are becoming worried about his, though your pediatrician says that your child will probably outgrow the problem within a year. Finally you decide to get another opinion.
Maybe you don't absolutely trust your pediatrician's take on your child's problem. Maybe you're just driven by the concern that we all have about our children when something seems wrong. In any event, while it's usually far better to work through your pediatrician when you want a second opinion, some parents take matters into their own hands and do self-referrals to specialists. (Of course, some people don't have that option, depending on the specifics of their insurance plan.)
Why Second Opinions?
You shouldn't view getting a second opinion as a test of your pediatrician. In most cases a second opinion will confirm what your doctor originally reported. But there may be more than one option for treatment, and one approach may work better for your child than another.
For example, with recurrent ear infections, there are a number of accepted approaches: One doctor might suggest repeated antibiotic treatments, while another would prefer to insert ear tubes. In the end, a second opinion probably won't send you off in a totally new direction, but it's likely to make you feel more confident about whatever decision you make.
There are some drawbacks to relying too heavily on specialists, however. Some parents want a specialist to see their child whenever a health problem develops.
For example, if an odd skin rash appears, they want a pediatric dermatologist to look at it. It's true that a specialist will most likely be up-to-date on the latest tests and treatments for your child's ailment. But if your child just has contact dermatitis (your basic rash), which would clear up if you took some simple measures, a dermatologist will likely get your child involved in a round of time-consuming, worrisome, and expensive tests.
Telling Your Doctor
Often parents find that the most difficult aspect of getting a second opinion is the fear of insulting their doctor by going elsewhere. However, it's usually a mistake to go behind your doctor's back to get a second opinion. If a physician finds out, perhaps through casual conversation with another doctor or nurse, it can cause confusion and hard feelings.
Unless you have completely lost faith in your doctor (in which case you should be working with someone else anyway), you should see him as a partner in the care of your child. For one thing, your pediatrician will know which types of specialists you should go to, saving you time and money. Some specialists will not even see you if you have not been referred by a pediatrician or primary care physician. And sometimes, you'll get an appointment more quickly if your pediatrician makes the call.
Your doctor should give you two or three names. You don't have to use the people your doctor recommends (friends and relatives can also be a good source for finding a specialist), but asking at least lets her know you're going to speak to someone else and keeps her involved in the process.
Finding a Specialist
Your search for a specialist should not be rushed unless your child is facing an emergency. If you live in a small town or in the country, it may not be easy to get find a pediatric specialist. You may have to travel to the nearest children's hospital or major medical center to find what you need.
If your child has been diagnosed with a serious or chronic disease, consider getting in touch with a group or foundation that's been established to help such patients. The Juvenile Diabetes Association, for example, would help you search to find a qualified diabetes specialist in your area.
After you've made the appointment, ask your pediatrician to give you a copy of your child's records to take to the new doctor. Sometimes the doctor will want to send them over himself. If your consulting doctor asks for tests, be sure to ask if the records from your original doctor contain the results. In most cases, there's no reason to redo tests unless the initial results were ambiguous.
Questions to Ask
You may feel anxious and intimidated by the specialist. Write down your questions ahead of time so you don't forget to ask them once you're face to face. Take along a notebook so you can jot down the answers.
Here are some general questions you should be sure to ask:
- Is there any way, through tests or medications, to confirm this diagnosis?
- What course of treatment do you recommend?
- Is this the conventional treatment for this ailment?
- What successes have you had with this treatment?
At the end of the appointment, make it clear that you want the specialist to report any findings to you as well as to your pediatrician. Always ask for a detailed written explanation of your child's condition and the recommended course of treatment, so you can review it and share it with others involved in your child's care.
If the other doctors agree on the diagnosis but not on the treatment (a common scenario), you should discuss with each why he suggests one course of treatment over another. You should, of course, tell him that his suggestions differ from another doctor's. Ideally, your pediatrician will help you decipher any conflicting information and decide what to do.
If your pediatrician disagrees on how to proceed with your child's treatment, consider calling in another specialist. If you've used a local doctor the first time around, you might consider tapping someone connected with a respected university hospital for the second consultation.
Keep in Mind
Throughout the process of testing and consultations, remember that no one cares or knows as much about your child's health as you do. You are the most critical figure in keeping your child healthy, and your child is depending on you to be his advocate.
7 Signs You Need a Second Opinion
1. Surgery is Recommended.
You want to be sure that there isn't another course of treatment that would make an operation avoidable.
2. The Diagnosis is Uncertain.
If your child had been through a battery of tests with no definitive results, your doctor may be as frustrated as you are. Perhaps another physician will have seen a similar case or may simply have a fresh perspective.
3. The Diagnosis is Serious.
You'll want a specialist to confirm the diagnosis and recommend a source of treatment. In some cases, when the diagnosis is unusual or very serious, you may want to consult with two or more specialists.
4. The Recommended Treatment is Risky or Controversial.
Sometimes a suggested therapy will be experimental or will have side effects that you find troublesome. Another doctor may suggest an alternative that's more acceptable for you and your child.
5. Your Doctor's Current Treatment is Not Working.
Say your child has been treated for severe allergies for two years and things just aren't improving. First you should ask your doctor if there are any other ways to resolve the situation, or other causes that should be explored. But if your doctor doesn't seem prepared to move in another direction, it may be time to see a specialist.
For example, your child might have a form of asthma that requires different treatment. A pulmonologist or allergist may be able to recommend a successful remedy.
6. You Want to Evaluate How a Course of Treatment has been Proceeding.
Perhaps your child has arthritis or another chronic ailment and has been under the care of a certain doctor for a period of time. The treatments have been going well and you think your child is doing fine -- or perhaps you think your child could be doing better.
In any case, it could be worthwhile to consult with another doctor to get a fresh look at the situation. The consulting doctor may simply confirm what your regular doctor has been doing. Or perhaps the consultant will see something new that could alter and improve treatment.
7. Your Confidence in Your Doctor is Shaken.
On occasion you may feel that your doctor doesn't seem to be doing a very good job for your child. Perhaps he isn't comfortable treating the condition your child has, or maybe he isn't connecting with you as a parent. In this case you should consult with another doctor, if only for your own peace of mind. You may find that your original doctor is recommending a good course of treatment, and this will be reassuring.
From the book The Savvy Mom's Guide to Medical Care: Everything You Need to Know to Get Top Quality Care -- From One of the Nation's Leading Physicians. Copyright 1999 by Pamela F. Gallin, MD, and Kathy Matthews. Reprinted by arrangement with St. Martin's Press, KKC, New York, NY.