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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.

    4. Heart Procedures continued...

    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.

    Why do the two disorders become confused? Some patients with bipolar disorder -- also called "manic-depressive illness" -- don't have a manic episode early on, so it's easy for doctors to mistake the two diseases. In fact, patients with a less severe form of bipolar disorder may never develop intense mania, but instead have milder manic episodes that alternate with depression.

    In fact, as many as 69% of bipolar patients may receive a wrong initial diagnosis, according to Mark Graber, MD, chief of the medical service at the VA Medical Center in Northport, N.Y. Graber has done research to find ways to reduce diagnostic errors.

    A proper diagnosis matters. Doctors treat depression with drugs such as antidepressants, while bipolar disorder typically requires mood stabilizers, such as lithium, either alone or in combination with antidepressants. When bipolar patients take antidepressants alone, they're at risk of switching into mania or developing rapid cycling between the highs and lows.

    "I'm actually all for psychiatric intervention in the primary care setting," Kim says. "I think it's perfectly reasonable to try an antidepressant, but people just have to be educated. They have to know that if they're having adverse effects to the medication that they should see a psychiatrist. Or if they do start to feel manic effects from the antidepressants, they should see a psychiatrist."

    But some patients balk, Kim says. "You almost have to hit them over the head to go to a psychiatrist. They would rather tough it out with their primary care physician because that way, they don't have to tell people they have psychiatric problems."

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    Reviewed on September 27, 2007

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