Seeking a Second Opinion

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While many patients may feel that it is disrespectful to their doctors to consult other physicians, getting a second opinion is a perfectly acceptable option if you are not satisfied with the medical advice you have received.

Pat Rich

But in Canada, the reasonableness of that option is somewhat at odds with results from a recent study by the Frontier Centre for Public Policy. Both in 2008 and 2009, this independent think tank, based in western Canada, teamed up with researchers in Europe to produce a consumer health index for Canada and 30 European countries. The index looked at a number of measures of health care, including patients’ rights and access to information.

iStockphoto.com/Tzu-Lan Hsieh

In both years, the index rated Canada last when it came to the issue of access to second opinions, because the right is not enshrined in Canadian law. “Many provinces and regional health authorities encourage consumers to request a second opinion if they are not confident in the diagnosis or recommendations of their physicians, but they provide no recourse for patients if such a request is denied,” says the Euro-Canada Health Consumer Index 2009 report. “Further, since a second opinion, from a specialist requires a referral and often a lengthy wait, even those regions that seek to provide second opinions have great difficulty in translating this into reality.”

In contrast, several of the provincial bodies that license physicians in Canada expressly note that patients have a right to a second opinion. Even so, professional feelings can be bruised when second options are sought.

“Whenever I have been involved in getting a second opinion, there always seems to be hard feelings,” says Nancey Roach, a registered nurse who serves as a patient navigator for Cancer Care Nova Scotia and deals with physicians who specialize in cancer care.

“I do not discourage people from seeking a second opinion if their minds are made up,” says Pelletier

Family doctors note that their patients rarely request second opinions, but when they do, most doctors are more than happy to arrange them. “I never resent a patient asking for a second opinion” says Vancouver family physician Dr. Jack Burak. Adds Dr. John Maxted, associate executive director of health and public policy at the College of Family Physicians of Canada, “Patients do ask for second opinions, just as you might want a second opinion on anybody else’s advice for a non-health-related issue. There are many situations where, as the patient’s physician, I myself would like a second opinion to make sure that I have done the right thing and am providing the right advice.”

But Maxted admits that some physicians may take offence and see such a request as “a vote of non-confidence” in their services. But for Dr. Mike Evans, a Toronto-based family physician and researcher, the patient may have a different motivation. “There are quite a few times when patients are seeking second, third or fourth opinions, but in a way they are looking for an answer they want to hear — not necessarily the right one.” That can be tricky to manage. “Do you let them go on their journey or do you intervene? I probably do a bit of both,” says Evans.

For Dr. Steve Pelletier, a family physician in Rockland, Ont., requests for second opinions usually boil down to a communication problem between doctor and patient rather than a lack of confidence in the expertise of the physician. A patient may not fully understand what he has been told and really just want someone to explain the situation more fully. “I do not discourage people from seeking a second opinion if their minds are made up,” he says. “Where I think it is in the best interest of the patient, I try to explain why it might be better to pursue the issue with the specialist they have already seen and perhaps clarify their own expectations for a future visit.”

Remember: you have a right to seek the opinion of another physician if you are dissatisfied with a diagnosis or suggested course of treatment. Although you may feel awkward doing so, it’s your health that’s at stake and, ultimately, you are its master.