Guide

How to get a second opinion, and how to read the evidence behind your diagnosis

A second opinion is a review of your diagnosis or treatment plan by another qualified doctor, usually a specialist in the same field. In Australia, the simplest route is to ask your GP or current specialist for a referral and to have your records, test results and scans sent ahead. Asking is common, and it is your right.

This is information about reading evidence, not medical advice. Talk to your doctor or pharmacist before changing anything.

When people ask for one

There is no single rule. Australian health information services describe the usual reasons:

• you are unsure about a diagnosis, or it does not seem to explain your symptoms;
• you are facing surgery, a long course of treatment, or a treatment with serious side effects;
• you want to be sure the planned treatment is the best option for you;
• you do not understand the diagnosis or the recommendation, or you do not feel comfortable with the doctor.

healthdirect puts it plainly: "You have the right to ask for as many opinions or referrals as you want." The Cancer Institute NSW adds a fair caution for cancer care: not everyone wants a second opinion, and you may need to weigh whether getting one will delay the start of treatment. That is a question to ask your treating team directly.

How to get a second opinion in Australia

1. Tell your GP or specialist you would like another view. Doctors are used to the request. You can name a specialist or ask for a recommendation.
2. Get a referral. Specialists usually need one, and a referral is generally needed for Medicare to cover part of the cost. Check fees with the second specialist's rooms before you book.
3. Have your records sent. Ask for your history, test results, imaging and pathology reports to go to the new doctor. It can save repeating tests. My Health Record can help share some of this.
4. Book promptly. Better Health Channel (Victoria) suggests making the appointment as soon as you have the referral, so a decision about treatment is not left hanging.
5. Keep your first doctor in the loop. It is usually easier when both doctors can see the same information.

Outside Australia the steps differ (insurers in the US, for example, may have their own rules). Check with your insurer or health service.

Why diagnosis is hard, and what the research says

Diagnosis is a process, not a single moment. The US National Academies of Sciences, Engineering, and Medicine describe it in their 2015 report Improving Diagnosis in Health Care as "a complex, collaborative activity that involves clinical reasoning and information gathering." The same report concludes that it is likely "most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences," where a diagnostic error means an inaccurate or delayed diagnosis.

Two studies give a sense of scale, with limits worth stating:

• Outpatient error rate. Singh and colleagues (BMJ Quality & Safety, 2014) combined three US studies and estimated an outpatient diagnostic error rate of about 5%, or roughly 12 million US adults a year, and estimated that about half of those errors could be harmful. These are extrapolations from US clinic populations, not a measure of any one doctor or any one country.
• Referred cases. Van Such and colleagues (Journal of Evaluation in Clinical Practice, 2017) looked at 286 patients referred from primary care to a single US academic centre. The final diagnosis was the same as the referral diagnosis in 12% of cases, better defined or refined in 66%, and distinctly different in 21%. These were complex, undifferentiated cases sent for specialist review, so the figure does not apply to every diagnosis.

Read together, these say diagnosis is difficult and a second look sometimes changes things. They do not say your diagnosis is wrong, and most second opinions in the referral study refined rather than overturned the first.

Questions to bring to the specialist

Write them down before the appointment. Useful ones:

• What is the diagnosis, and how sure are you? What else could it be?
• Which tests support it, and is any result still missing?
• What are the options, including waiting and watching? What does each involve?
• What evidence supports the recommended option? Is it a guideline, a trial, or experience?
• If you disagree with the first opinion, what would help resolve the difference?
• How long can the decision safely wait?

Bring a list of every medicine and supplement you take, and someone to take notes if you can.

Reading the papers your doctor mentions

Sometimes a doctor will point to a study, or you will find one yourself. A few habits help you read it without being misled:

• Check what kind of study it is. A randomised trial, a cohort study and a case report carry very different weight. A systematic review of good trials usually carries the most.
• Check who was studied. A result in 40 adults of one age group may not apply to someone different.
• Look for the full paper. A conference abstract or a press release leaves out the methods. Treat it as a signal, not a result.
• Separate what was found from what the authors suggest. The discussion section often goes further than the data.
• Bring it back to your doctor. The question is not "is this paper right?" but "does this apply to me?" Only your clinician can answer that.

Where MIA fits, and where it doesn't

MIA (Medical Intel) is a literature desk. You put a paper you already have on the desk and ask what it will bear. The working separates three things: what the paper shows, what may reasonably be drawn from it, and what it does not establish. An abstract without the full paper stays a gap. Standard of care is kept apart from investigational claims by default. You can attach a PDF or connect Google Drive or Dropbox.

What MIA does not do matters as much. It is not a clinician. It does not diagnose, it cannot tell you whether your diagnosis is right, it does not recommend treatment and it gives no dosing. It does not help you find, book or pay for a second opinion. It is a way to read the papers more carefully before you talk to your doctor.

Read a paper on the desk: 150 free credits, no card.

FAQ

Is it rude to ask for a second opinion? No. It is a common request and you have the right to ask. Most doctors will help with the referral and with sending your records.

Do I need a referral for a second opinion in Australia? Usually, if the second doctor is a specialist. A referral is generally needed for Medicare to cover part of a specialist's fee. Check the fee with the specialist's rooms.

How common is misdiagnosis? Estimates vary by setting and method. A 2014 study estimated that about 5% of US adults in outpatient care experience a diagnostic error each year. The National Academies concluded that most people will experience at least one diagnostic error in their lifetime.

Can AI tell me if my diagnosis is correct? No tool should be relied on for that. AI can help you read and understand a paper, but whether a diagnosis is right for you is a clinical judgement. MIA does not diagnose.

This is information about reading evidence, not medical advice. Talk to your doctor or pharmacist before changing anything.

Sources

- National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: National Academies Press; 2015. https://nap.nationalacademies.org/catalog/21794/improving-diagnosis-in-health-care - Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014;23(9):727-731. doi:10.1136/bmjqs-2013-002627 - Van Such M, Lohr R, Beckman T, Naessens JM. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747 - healthdirect. What is a referral? (section "How do I get a second opinion?"). https://www.healthdirect.gov.au/what-is-a-referral - Better Health Channel (Victoria). Second opinions. https://www.betterhealth.vic.gov.au/health/servicesandsupport/second-opinions - Cancer Institute NSW. Getting a second opinion. https://www.cancer.nsw.gov.au/general-cancer-information/diagnosis-and-treatment/diagnosis/getting-a-second-opinion

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