Right to a Second Opinion

Positive interactions and most importantly trust between the patient and their healthcare team are important factors to a patient’s health and well-being as well as healing. Of these interactions, the relationship between patient and physician is a sacred cornerstone that has existed across cultures and generations for hundreds of years.

This respectful alliance is built upon mutual trust and understanding of the rights and responsibilities of both patients and physicians. As such, we explore aspects of this relationship in this blog and discuss a patient’s right to a second opinion within the context of their care experience.

Patients and physicians have rights and responsibilities in a healthcare encounter. According to the American Medical Association (AMA) Code of Medical Ethics Opinion 1.1.3, some of these patient rights are:

• To courtesy, respect, dignity, and timely, responsive attention to his or her needs.
• To receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits and costs of forgoing treatment. Patients should be able to expect that their physicians will provide guidance about what they consider the optimal course of action for the patient based on the physician’s objective professional judgment.
• To ask questions about their health status or recommended treatment when they do not fully understand what has been described and to have their questions answered.
• To make decisions about the care the physician recommends and to have those decisions respected. A patient who has decision-making capacity may accept or refuse any recommended medical intervention.
• To have the physician and other staff respect the patient’s privacy and confidentiality.
• To obtain copies or summaries of their medical records.
• To obtain a second opinion.
• To be advised of any conflicts of interest their physician may have in respect to their care.
• To continuity of care. Patients should be able to expect that their physician will cooperate in coordinating medically indicated care with other health care professionals, and that the physician will not discontinue treating them when further treatment is medically indicated without giving them sufficient notice and reasonable assistance in making alternative arrangements for care.

Moreover, patients’ responsibilities include being honest and forthcoming with their physician about their conditions, their compliance with treatments, and answering questions that are relevant to their care.

Amongst physicians’ responsibilities to patients are autonomy, beneficence, justice, and nonmaleficence. The principles mean the following:

• Autonomy: respecting a patient’s right to making final medical decisions for themselves after they are presented with and educated on options and alternatives (assuming a patient’s competence and capacity to making decisions is intact)
• Beneficence: always acting in the patient’s best interest
• Justice: fair and equitable distribution of health resources
• Nonmaleficence: the physician’s obligation to do no harm

A second opinion is simply when another physician gives their opinion on any medical conclusion, such as a diagnosis or how a certain condition should be treated, after you receive an opinion from your initial physician. Second opinions may result in the same or different conclusion depending on the nuances of the clinical case.

It is important to note that medicine is often as much of an art as it is a science, and physicians may have different opinions based on their professional experience and interpretation of the situation at hand. Alternatively, it is also possible for you to be presented with two different, but just as reasonable medical opinions.

Second opinions may be warranted in clinical situations that require treatment decisions associated with some risks to the patient and where there is some controversy about the exact course of action. However, patients should seek a second opinion at any point when they feel more information from another physician would be beneficial. Reasons to look for a second opinion may include the following:

• To confirm a diagnosis, especially if the recommended treatment may not appear to be resolving your symptoms
• To better understand your condition and hear different perspectives
• To learn about other treatment options before committing to one
• To find a healthcare team that can provide recommendations that align with your health goals  
• To gain additional confidence in your final decision

Clinicians and surgeons have diverse backgrounds and training experiences that can offer valuable insight. Fellowship trained subspecialists with more experience managing specific types of disorders may be consulted. Even if a second opinion is identical to the first, it can be reassuring knowing that you have explored different perspectives. 

Physicians should not take offense to a request for a second opinion. It is important for physicians and patients to communicate openly and honestly with each other. Many patients want to confirm that a specific diagnosis or plan is indeed the best way to proceed with a medical or surgical encounter, especially if the recommendations carry some risks or symptoms are still being experienced. Given that the chief goal of healthcare is to promote the health and well-being of the patient, a request for a second opinion should be supported.  

Although each insurance company has its own policies, Medicare and various private insurance plans typically offer coverage for second opinions under certain circumstances. As always, consult your insurance company to learn more about your policy and how it would apply to your care.

• Physicians have the duty to provide the patient with care that maintains autonomy, beneficence, justice, and nonmaleficence.
• Second opinions are within a patient’s rights and are helpful in unclear clinical situations or when initial recommendations do not align with the patient’s healthcare goals.
• Second opinions are often covered by insurance providers such as Medicare or private insurance, but patients should consult their plan specifications to better understand what will and will not be covered

• American Medical Association
• Medicare