Getting a second opinion: 3 ways to make sure you get it right

If you’re thinking about a second opinion, you probably feel like your injury has been misdiagnosed or mismanaged.

A second opinion can serve an important and vital role in injury management -no one wants to waste time and money trying to rehabilitate a calf muscle injury that’s actually a blood flow problem

Knowing when and how to get a second opinion to make it most effective is the key, as well as knowing how to respond to the outcome.

Why are some conditions misdiagnosed?

Misdiagnosis typically occurs when a clinician places too much emphasis on a particular aspect of a case, eg. If the patient has pain at night or has lost weight recently.

This happens when the follow up questioning isn’t detailed enough or the answers are not explored and confirmed.

We see this most often when there is time pressure and our time with the patient is limited due to workload or scheduling.

The average time that a medical specialist gives a patient to respond to a question before asking the next question is only 7-8 seconds!

Misplaced emphasis can also occur when the patient overemphasises a particular aspect of their history, such as the pain starting the day after they tripped in the park.

This emphasis often happens for a number of reasons:

  1. due to concerns of the patient about the event (“I think it may have causes some damage”),
  2. their own reasoning of the association between the two (“When I fell, I think the knee could have twisted and torn a ligament”), or
  3. external input from well-meaning friends/social media about the link between their symptoms and a potential cause (“I heard this guy fell like that and ended up with a fractured kneecap!”).

There’s nothing wrong with forming your own theory, or doing your own research, or even asking friends for advice.

Unfortunately it can weigh on the clinician’s reasoning, particularly with an inexperienced clinician, and can affect the diagnostic outcome.

How you can help to get the right diagnosis

To aid in objectivity, I recommend the following to my patients:

1. Keep an activity log

This includes what you were doing and how your symptoms behaved over the course of at least 3-4 days.

This can help to isolate aggravating activities and look at trends over a longer time frame.

it’s worth noting that everything hurts in the first few days after a sudden onset injury, so recording details after the first 72 hours is more helpful.

2. Get several photos of the injury over the first 3-5 days

This helps to show how the injury responded and the pattern of swelling or bruising over the time.

That pattern can actually help us determine where the swelling is located and, by deduction, where it originated.

If we know which structure or area is causing the swelling, we know where to look for the injury.

3. Ask observers for their input

Much like the police interviewing witnesses to a car accident, the most unbiased observations often come from those around us.

Ask family and friends if they’ve noticed anything about the way you move, your posture, habits or any other changes that coincide with your symptoms.

But don’t put too much emphasis on the drama of the incident itself – note any observations about the way you fell or collided, but don’t worry too much about the “cherry on top” comments.

These are the comments like “you could see the bone” or “they heard the crack a mile away”…

Both are skewed by the excitement of the moment and both are very rarely true.

How do I know when to get a second opinion?

Seeking a second opinion should occur based on the expected timeframe and response to management of the original diagnosis.

Patients should always speak to their treating health professional and clarify their diagnosis as well as how long it should take before they should notice an improvement and/or be symptom-free.

As that timeframe approaches, discuss your progress with the treating practitioner and the reason for any delay in your recovery.

If you’re not seeing the expected recovery and you’ve exceeded the predicted timeframe by 50%, it’s time to confirm your diagnosis and management approach with a second opinion.

We need to view a second opinion as a way of confirming the diagnosis and plan, rather than being seen as doubting the initial findings.

Many patients are hesitant to seek a second opinion, thinking of it like cheating on a partner.

However, if the clinician feels threatened or offended by a second opinion, they’re either not confident in their work or their ego is affecting their judgement.

A confident clinician is never threatened by external input – it’ll either confirm they’re on the right track or discover something that was missed.

Either way, the patient gets a better outcome and isn’t that the overall goal?