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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 medicines.

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 says.

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.

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