When, and how, to get a second opinion

I've rarely met doctors who lacked confidence in their diagnoses and treatment plans. That's why we go to doctors, right? For their knowledge and expertise.

But as I've written before, the practice of medicine is based in science, yes, but there's a fair amount of art, too - intuition, judgment and even plain old guesswork.

That's why, if a diagnosis will require a major intervention, such as hospitalization, chemotherapy or surgery, I recommend to my clients that they seek a second, or even third, opinion. Two heads are usually better than one, and three might be better than two. There's research to show that second opinions make a difference. A 2017 study found that 21% of patients who sought a second opinion at the Mayo Clinic left with a completely different diagnosis; about two-thirds had their diagnoses confirmed but received refined treatment plans.

So the first question is: Should you get a second opinion? VeryWell Health, a partner of Cleveland Clinic, has a good list of considerations:

1. If you have undergone treatment and your symptoms persist, you should get a second opinion. This assumes you have followed your treatment plan as prescribed by your doctor.

2. If you are diagnosed with a rare disorder, you should get a second opinion. There are some 7,000 known rare disorders, according to the Genetic and Rare Diseases Information Center. I don't usually recommend Googling symptoms, but this is one time you should research doctors who have treated your disorder and, if necessary, contact them directly.

3. If treatment will require surgery or long-term therapy, or will have a lifelong impact on your quality of life, get a second opinion. Medicare covers second opinions if a doctor recommends you have surgery or a major diagnostic or therapeutic procedure. The same is true of some Medicare Advantage plans, but check your coverage to be sure.

4. If you are diagnosed with cancer, get a second opinion. Cancer is complicated with many treatment options. Some treatments are offered at some medical centers but not at others. There also may be clinical trials you could take part in.

5. If your instinct tells you something is "off," get a second opinion. You should feel comfortable with your doctor's diagnosis and proposed treatment. This is particularly helpful when you're trying to get a diagnosis for your child. You know your child and you know when something isn't right. Many pediatric disorders resolve themselves, so pediatricians tend to take a wait-and-see approach. If symptoms persist, though, it's time to get a second opinion.

The next question is: How do you go about obtaining a second opinion?

First, tell your physician you'd like a second opinion. Don't be shy about it, and this should not be adversarial. A good doctor will encourage you to explore your options.

Then, I recommend consulting with your insurance provider. They may only cover second-opinion consultations done by in-network physicians. Look for another doctor in the same specialty, but with a different medical group, because a doctor in the same group might not want to dispute a colleague's diagnosis. A patient advocate may be able to help you research appropriate medical professionals.

If you can't get an appointment in a timely way, try emailing the doctor directly. Before you have an appointment for a second opinion, make sure to have all of your records, test results and diagnostic images with you, or have them sent to the doctor in advance.

When you Google "second opinions" these days, you'll see there are also virtual and online second-opinion practices. If you can't find a specialist locally, this may be an option, but beware: It probably won't be covered by your insurance. For example, Cleveland Clinic's virtual second-opinion service is $1,850, payable up front.

So you get a second diagnosis that differs with the first one. What then? Medicare will cover a third "confirming opinion," even if it may not cover your procedure. Check with your insurance provider on their requirements.

But here is an important caveat: As long as you're seeking the soundest diagnosis and best treatment options, go for second and even third opinions. Just be sure you're not "shopping" for a diagnosis because you don't like what you're hearing from your doctors. Getting multiple opinions can become counterproductive and delay your treatment.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.