5 Diagnoses That Call for a Second Opinion
Experts tell WebMD about situations in which another medical viewpoint may be priceless.
3. Parkinson's Disease
"Parkinson's is one of the most difficult diseases to diagnose. There's
no blood test, X-ray, or instrument that would give you an answer," says
Executive Director Robin Elliott of the Parkinson's Disease Foundation.
Diagnosis of this neurological disorder -- marked by tremors, slow movement,
muscle stiffness, and loss of balance -- is based "not on a very specific
test, but a cluster of features," says David C. Dale, MD, president of the
American College of Physicians. Parkinson's can be especially difficult to
diagnose in the early stages.
The rate of misdiagnosis among people with Parkinson's may be as high as
25%-30%, Elliott says. In the elderly, the trembling and movement problems of
Parkinson's may be dismissed as normal aging. Conversely, patients may be
wrongly diagnosed with Parkinson's when their symptoms actually stem from side
effects of drugs they're taking, such as certain psychiatric
Even well-trained internists and general neurologists can have trouble
diagnosing Parkinson's disease, especially if they've had little experience
with the disorder, according to Elliott. As a result, the Parkinson's Disease
Foundation suggests that people diagnosed with Parkinson's consider getting a
second opinion from a neurologist who specializes in movement disorders and has
extensive experience with Parkinson's.
4. Heart Procedures
What prompts heart patients to seek second opinions?
"Probably the most common situation is that someone has been advised to
have open heart surgery or a coronary intervention or a catheterization, and
they're wondering if they really need that," says David L. Rutlen, MD, vice
chairman of ambulatory programs at the Froedtert and Medical College of
Wisconsin, which has a cardiac second opinion program. In other words, patients
want extra advice before consenting to invasive heart procedures that carry
serious risks, such as blood clots, stroke, infection, and even death.
A second opinion makes sense "if the patient has any concern that this
is a treatment plan that may not be best for them," Rutlen says. For
example, patients may wonder whether they truly need bypass surgery or if,
instead, they can undergo balloon angioplasty to open up blocked arteries.
Some patients also seek out a second opinion in hopes of finding an expert
with greater experience in performing the procedure they require, Rutlen
Also, if a patient remains undecided after the first cardiologist has listed
multiple treatment options, "a second opinion from another cardiologist
would be an excellent consideration," Rutlen says.
5. Depression and Bipolar Disorder
Primary care physicians often diagnose cases of depression, but sometimes a
second opinion from a psychiatrist is in order.
If patients diagnosed with depression don't improve after trying at least a
couple of antidepressants, or if they develop adverse effects, such as mania,
they may actually have bipolar disorder, says Florence Kim, MD. She is a
psychiatrist and director of the Menninger Clinic's Comprehensive Psychiatric
Service, where patients can obtain psychiatric second opinions.