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
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
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