Can I get more than one ‘second opinion’?

Question: My daughter suffers from a chronic runny nose. Our family doctor in Toronto referred us to specialist who suggested an operation to remove the adenoid tissue at the back of her throat. I was reluctant to agree to surgery because my daughter is only two years old.  I asked our family physician to send us to another specialist to get a second opinion.  But the second specialist was very abrupt. He asked if we had a family pet. When I said we had a cat, he told me to get rid of it. He said my daughter’s runny nose is likely an allergic reaction to the cat. I don’t feel our questions have been answered – and I don’t know what specialist is right. Are we entitled to another second opinion?

Answer: The short answer to your question is likely yes.  I am not trying to be coy or evasive. But, like many other health-related issues, there is often a caveat attached.

In Ontario, the provincial Ministry of Health does not place a limit on the number of second opinions a patient can seek for a particular medical condition.

“If a physician feels it is reasonable and medically necessary to obtain more than one second opinion, additional consultations may be requested, regardless of the time period,” David Jensen, a spokesperson for the ministry of health, said in an e-mail.

So the province will pay for you to see any number of specialists. The ability to seek out various points of view can be extremely valuable for patients who are diagnosed with a complicated disease, such as cancer, involving a variety of different treatments over a relatively short period of time.

The catch is that you need a referral from a physician to see another doctor for a second opinion.  The referral can by made by your family doctor or a specialist you have seen within the past year. (The exception is at a hospital emergency department or walk-in clinic where you can see a doctor without a referral.)

Doctors are essentially the gatekeepers of the medical system – and there is a certain amount of logic in this arrangement. After all, without some control, one patient could theoretically see an infinite array of doctors for the same medical complaint.

The issue gets a bit tricky when you try to define what’s a “reasonable” request for a second opinion, says Sally Bean, a medical ethicist and policy advisor at Sunnybrook Health Sciences Centre.

The Code of Conduct of the Canadian Medical Association instructs doctors to “respect your patient’s reasonable request for a second opinion from a physician of the patient’s choice.”

This wording suggests, “the patient has a sort of right to a second opinion, but how strong or weak that right is isn’t terribly clear,” says Ms. Bean.

In the United States, patient rights are more clear-cut. The Code of Conduct of the American Medical Association states: “Patients are … free to obtain second opinions on their own initiative, with or without their physician’s knowledge.”

But, of course, Canada and the United States have very different health care systems.  It’s true Americans have a stronger right to a second opinion, but that right is still limited to whose who can afford it – either through their insurance coverage or if they are willing to pay for the service out of their own pockets.

Ms. Bean says patients ask for second opinions for a lot of different reasons.  “Whether you really need a second or a third opinion … depends on the circumstances,” she adds. “There is definitely a lot of responsibility placed on the family physician, and specialists, to decide whether to refer patients to other specialists.”

With this background in mind, let’s return to your question about your daughter’s medical condition.

You mentioned that two specialists have already seen her. One suggested the runny nose maybe improved with an operation to remove her adenoid tissue. The other strongly implied her condition is related to allergies.

You will need to go back to your family physician and discuss what you’ve been told. It’s possible your doctor may be able to offer some fresh insights based on his knowledge of your daughter’s medical history.

But it sounds like the two specialists don’t agree on the underlying cause of the problem. If your doctor concludes that is the case, there’s a strong likelihood he will refer your daughter to another specialist for one more second opinion.  And, hopefully, that referral will provide some clarity.