This column is part of a series of firsthand physician accounts that detail how AMA Health System Program members are moving medicine to support patient health and the medical profession.
No two diagnoses or injuries are identical, and physician opinions often differ. Medicine blends data, experience and judgment. This inherent nuance often leads patients to seek a second opinion—a crucial aspect of health care management and patient empowerment. When diagnoses are complex and treatments multifaceted, another physician’s perspective can be invaluable.
Patients seek second opinions for various reasons: confirming a diagnosis, exploring alternative treatments, or clarifying a recommendation that seems aggressive or unclear. This process allows access to a broader range of expertise, empowering patients to make informed decisions. A second opinion might validate the initial diagnosis or offer a different viewpoint, potentially altering the treatment plan. Sometimes, it can even uncover a misdiagnosis or reveal less invasive options.
Still, second opinions can have drawbacks.
Additional consultations mean more appointments, tests and time, leading to increased costs and potential emotional strain. Furthermore, differing opinions can create tension between physicians and within the patient-physician relationship. Patients might feel caught between conflicting recommendations, while physicians might feel their judgment is questioned. This situation can sometimes necessitate a third opinion.
Ultimately, the decision rests with the patient, and we understand and appreciate this. Patient autonomy is paramount, and seeking additional input is a crucial part of that right. At its best, medicine is collaborative, and second opinions can enhance the quality and safety of care.
There are many benefits
Second opinions can also reduce medical errors. Despite rigorous training, diagnostic errors occur. A fresh perspective can catch something missed due to cognitive bias, time constraints or human error. Studies show second opinions lead to significant changes in diagnosis or treatment in a substantial percentage of cases, especially in oncology, orthopaedics and neurology.
Furthermore, when approached transparently, second opinions can build trust between patients and physicians. A physician encouraging a second opinion demonstrates confidence and prioritizes the patient's understanding. This fosters trust and respect, strengthening the therapeutic alliance and improving adherence to the treatment plan.
The AMA Code of Medical Ethics, for example, says that “physicians’ fiduciary obligation to promote patients’ best interests and welfare can include consulting other physicians for advice in the care of the patient or referring patients to other professionals to provide care.”
Subscribe to learn how innovative health systems reduce physician burnout.
It’s different than “doctor shopping”
However, there's a distinction between legitimate second opinions and "doctor shopping."
Doctor shopping involves visiting multiple providers to obtain a desired diagnosis or treatment, regardless of previous medical advice. This behavior, driven by distrust, dissatisfaction or manipulation, can fragment care, leading to duplicated tests, conflicting treatments, and potential drug interactions. It also undermines the physician-patient relationship.
The difference between a genuine second opinion and doctor shopping lies in the intent.
One represents a proactive, informed approach, while the other signals distrust or manipulation. Recognizing this difference is crucial for both patients and physicians and requires open communication and mutual respect.
Create a healthy relationship
Physicians should never view second opinion requests as personal affronts. Instead, they represent a patient's desire for understanding, which physicians should respect and encourage. Handling these requests professionally maintains a healthy doctor-patient relationship.
When asked for a second opinion, physicians should guide patients toward qualified specialists. A collaborative approach prioritizes patient well-being and reflects confidence in the physician’s own judgment while acknowledging the value of diverse perspectives.
The second-opinion physician must offer an objective perspective without appearing to "steal" the patient. While some patients may switch providers, the second-opinion physician should focus on clinical facts, avoid criticizing prior care, and present recommendations professionally. The goal is to contribute to the patient's decision-making, not to compete for their loyalty.
Finally, patients must choose their path forward. Upholding patient autonomy means respecting their choice, whether they return to the original physician, switch to the second, or seek a third opinion. Physicians should foster trust, ensure clarity, and support the patient's decision. Second opinions can also be learning opportunities for physicians, providing insights into alternative approaches and enhancing their practice.
Second opinions are a vital tool for patient empowerment, safety and informed decision-making. They can lead to better outcomes and foster trust but also present challenges that require careful navigation. Doctor shopping, conversely, threatens the integrity of care.
When both patients and physicians approach the process in good faith, second opinions elevate the standard of care and reinforce medicine's collaborative spirit.
Dr. Bitterman is an orthopaedic surgeon at Northwell Health, New York’s largest health system and a member of the AMA Health System Program. He is also an assistant professor of orthopaedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
