Overview of Seeking a Neurosurgical Second Opinion

• What is the purpose of a second opinion?

• Patients have a right to a second opinion

• Can a physician refuse a second opinion?

Neurosurgical care is complex and, in many cases, can be life altering. Having been presented with a diagnosis or a treatment plan, patients may want to seek a second opinion for a variety of reasons. In this section, we describe the patient’s right to ask for a second opinion, when it can be beneficial, and the process of doing so.

Patients often ask what the purpose of a second opinion is and when they should seek one. The reasons for seeking a second opinion vary and may be different for every patient. Some common reasons include interpersonal difficulties in the patient-physician relationship, the treatment options presented to the patient do not align with his or her treatment goals, or the patient has a particularly serious or rare condition that he or she feels can benefit from seeking more expertise. Ultimately, a second opinion can provide more confidence in your care plan and this confidence can be very reassuring and worthwhile.

Interpersonal difficulties may arise when a patient feels that they are not being listened to or that their physician does not share their core values. The patient-physician relationship is often intimate and requires mutual respect. Seeking a second opinion can help someone find a physician they fully trust. Patients may also feel that the treatment option presented does not meet their goals and expectations. Patient goals are variable, and a second opinion can help a patient find a physician who best aligns with their expectations.

For instance, some neurosurgeons may offer conservative management such as watchful waiting or medications, while others may recommend more aggressive modes of treatment such as surgery early on. Both approaches can be correct, but one option may be better suited to a patient’s goals and expectations.

Finally, in some instances of rare or particularly complex disorders, it may be beneficial to seek out a surgeon who has more experience in managing similar conditions, or is fellowship-trained in that domain. This type of expertise may be found at larger academic centers but comes with difficulties in logistics such as scheduling or travel and the benefit may be negligible in less complex cases. Ultimately, the decision to seek a second opinion varies between individuals but patients should not hesitate to seek one if they feel it will help them meet their treatment goals. 

In the patient-physician relationship, patients have specific rights as described by the American Medical Association (AMA). Broadly, this includes the right to have an open discussion of treatment options which will allow for informed decisions regarding care. To remain informed, patients have the right to obtain a second opinion about their diagnosis or treatment plan from another physician.

When exercising your right to a second opinion, it is important to recognize that physicians may reach the same conclusions about a diagnosis or treatment plan. However, in some instances, opinions may differ because of variations in professional experience and training. This does not necessarily mean that one opinion is wrong, just that practice styles vary in select situations. Oftentimes, both opinions are reasonable, and patients can choose which treatment plan best meets their specific goals.

People often ask if a physician can refuse a second opinion. Patients may be nervous and worry that asking for a second opinion is rude and will offend their physician. This is not the case, and most physicians recognize that asking for a second opinion can be immensely valuable and should be respected and encouraged.

Neurosurgical care is complex and conscientious neurosurgeons will recognize the importance of leaving no stone unturned. When seeking a second opinion, it is important to be open and honest about your concerns so that the two physicians can collaborate and develop the best possible treatment plan that meets your individual goals.

While refusing to refer a patient for a second opinion is inappropriate, physicians do have the right to refuse to prescribe certain medications if they determine that doing so would be wrong. Similarly, physicians can refuse to treat patients if they feel that treatment is unnecessary, the patient is abusive or threatening, or the treatment required is outside of their scope of practice. Refusal to prescribe certain medications or treat conditions must be medically indicated and cannot be based on individual factors such as a patient belonging to a certain group, race, or gender.

Asking and receiving a second opinion is an important right afforded to patients. Patients may want a second opinion for any number of reasons and doing so can be important to meet their care goals.

• Patients have a right to receive a second opinion so that they can make informed decisions about their care.
• Most conscientious physicians recognize the importance of a second opinion and will not be offended if a patient requests one.
• Patients can ask for a second opinion for many individual reasons and should not hesitate to do so if they feel it is necessary to meet their care goals.

• American Medical Association
• American Cancer Society