Find an Expert
Start with a specialist, neurologists say. You can find one through several channels. Your community may have neurologists, in private practice or hospital-based settings, who have additional training in neurology subspecialties and are knowledgeable and experienced in that field. Another good source is a large clinic that employs a variety of specialists, says Anup D. Patel, MD, FAAN, section chief for neurology and director of epilepsy at Nationwide Children's Hospital in Columbus, OH. You also can call the nearest academic medical center, which tends to employ doctors who have conducted research and are up to date on treatments. Or browse the medical center's website and look through biographies of neurologists, which usually include their specialties and links to their published studies.
Academic institutions have access to a range of tests, including genetic testing, which can help physicians tailor treatments, says Dr. Patel.
You also may be referred to Centers of Excellence—clinics that offer comprehensive, interdisciplinary care and related resources centered on a particular condition and are designed to provide the best patient outcomes possible.
Advocacy groups are another resource. They can help connect you with a specialist. Your own doctor is another excellent resource, says Katherine H. Noe, MD, PhD, FAAN, associate professor of neurology at Mayo Clinic in Phoenix. “Start by saying, ‘I'm feeling confused and overwhelmed, and I feel that a second opinion would be valuable. Who would you see if you were in my position?’ In my practice, I suggest who I think would give the best second opinion and help make that connection.”
Send Medical Records
The first thing to do once you've secured an appointment for a second opinion is to get your medical records transferred. “I oftentimes don't receive those records,” says Demetrius M. Maraganore, MD, FAAN, chair of the department of neurology at Tulane University School of Medicine in New Orleans. “If I'm being asked by the patient or the referring physician to give an update, do I delay my evaluation and assessment while I track down medical records, and will I even be able to do that?” Without records, the second physician has to reorder tests and redocument your medical history.
Ask your neurologist or primary care doctor to transfer test results and notes from your most recent appointments. Likewise, ask your second opinion doctor what information he or she would most like to see from the physician who gave you a first opinion. Consider also bringing hard copies with you in case the information isn't sent or received prior to the appointment, Dr. Patel says. Be judicious about how much information you share with the second physician, advises Dr. Maraganore, who has had patients wheel in small suitcases full of medical records. Relevant documents include recent test results and imaging scans and a list of current and previous medications.
Write Down Questions
Before the appointment, draft a list of questions, says Dr. Patel, who recommends asking if the new physician believes your diagnosis is accurate and whether additional tests would provide more information. Other questions might include “Why do I have this condition?”, “Is the treatment appropriate for me [or my child]?”, and “Would you recommend other treatments?”
Bring Backup
Listening to and trying to absorb medical information can be difficult and overwhelming, says Dr. Patel, who suggests that patients ask a family member or close friend to accompany them to take notes during the appointment.
Check Your Insurance
Ask the office staff to confirm that the doctor is in your insurance network and find out if your insurance covers the visit. This can help avoid unexpected out-of-pocket costs.
Resolve Differences
If the second medical opinion differs from the first, talk to both physicians about the differences, suggests Dr. Noe. Ask them why they made their recommendations. In some cases, a third opinion may be necessary to resolve any lingering doubt over conflicting opinions, according to Dr. Patel. Anything beyond that is likely not helpful, Dr. Noe says.
“Sometimes the diagnosis or treatment is actually fairly straightforward, but patients and their families are struggling to accept it,” she says. “Seeking fourth or fifth opinions ends up adding to the confusion and delaying care.”
In general, Dr. Patel says, it makes sense to follow the advice of a physician who is an expert in your condition.
Virtual Second Opinions
If you don't live near an academic medical center, can't travel to one easily, or cannot find an experienced expert locally, consider seeking a second opinion via videoconference. The following institutions offer remote second opinion programs.
- The Clinic by Cleveland Clinic: clinicbyclevelandclinic.com, 216-445-5588
- Houston Methodist: houstonmethodist.org, 713-441-2340
- Massachusetts General: massgeneral.org, 617-726-2000
- New York-Presbyterian: nyp.org, 877-697-9355
- Stanford Medicine: stanfordhealthcare.org, 877-254-3762
- UCLA Health: uclahealth.org, 310-825-2631
- UC San Diego Health: health.ucsd.edu, 858-657-7000
- UCSF Health: ucsfhealth.org, 888-689-8273
- University of Chicago Medicine: uchicagomedicine.org, 888-824-0200
- Yale Medicine: yalemedicine.org, 877-YALEMDS
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