The 5 W’s of Second Opinions

So, you think you should get a second opinion about your hip. What does that even mean? Why seek another opinion? Who should you see? Where do you choose to go? When should you seek another opinion? How do you make it happen? Read on to have all your questions answered

1. WHAT does it mean to get a “second opinion?”

A second opinion is simply just that – another opinion from a second healthcare provider. Hips are some of the most complex joints in the body and different providers may have different opinions on how to treat, so getting opinions from two or more surgeons who have advanced training or expertise in treating the hip may be helpful to patients.

2. WHY would a patient decide to get a second opinion?

You might choose to get a second opinion for several reasons. A second opinion may confirm a diagnosis and treatment options. Different surgeons may have different opinions on how to treat a hip condition, so knowing about different options may be helpful to make your decision about surgery.

3. WHO do you see for a second opinion?

Hip surgeons often specialize in different types of surgeries including arthroscopic (“scope” or “key hole”) procedures, open hip preservation surgeries (such as osteotomies and surgical hip dislocations), and joint replacement surgeries. Some surgeons may specialize in one of these areas and others may be trained to perform several of these specialized hip surgeries.

When choosing who to see for opinions, important variables to consider include:

  1. Your hip condition or diagnosis
  2. The surgeon’s training and areas of expertise

Depending on your individual characteristics, preferences, and values, these may also be important to consider:

  • Inter-personal factors such as communication style and general rapport. Although the importance of this may vary between patients, having a good patient-provider relationship who supports your needs, values, and goals as a patient may impact long-term outcomes.
  • Location
  • Insurance

There are many ways for patients and families to find providers to see for opinions:

  • The International Hip Dysplasia Institute (IHDI) has a list of hip surgeons from around the world who are involved in hip dysplasia-related advocacy, education, and research:
  • Visit surgeon, hospital, and orthopedic practice websites to learn more about individual surgeons’ education, training, research, and areas of expertise. Many pages provide links to providers’ curriculum vitaes (“CV”) which provide detailed information about their educational and clinical backgrounds.
  • Ask your primary care physician, orthopedist, physical therapist, or other medical providers if they can recommend a specialist based on your individual case.
  • Family members, friends, colleagues, and other patients can also be helpful to ask for recommendations since they have had first-hand experiences with providers. However, it is important to remember that different patients have different healthcare needs and the “right” healthcare provider for one patient may not be the “right” healthcare provider for you.

4. WHERE to go for a second opinion

When it comes to figuring out where to go for your second opinion(s), there may be a few things to consider.

  • What insurances are accepted by the surgeon and hospital systems he or she works with? Office visits, imaging, surgeries, and hospitalizations can be very expensive. Knowing what types of costs to expect is important to many patients.
  • Where is the surgeon located? Many patients travel to see specialized hip surgeons for consults and for treatment, however traveling for care can be challenging for some patients. Patients should think about logistics of traveling for medical care. These can include the out-of-pocket costs and time related to travel and lodging and the logistics of traveling with pain or decreased mobility before or after surgery. Sometimes surgeons’ offices will be able to provide information or assistance with logistics for patients are from outside the region. Talking to other patients who have traveled for consults or surgery can also be helpful for learning tips and tricks from others who have traveled.

5. WHEN to go for a second opinion

It is never a bad time or too late to get a second opinion.

Some patients get multiple opinions before they have any hip surgeries. This is especially important if you are planning on undergoing a complex hip surgery. Some surgeons will even encourage their patients to get a second opinion before deciding to have surgery.

A second opinion may also be helpful if you have had previous hip surgery and still have pain or limited function. When possible, it is helpful to include your original surgeon in the discussion about when to get a second opinion after a previous hip surgery.

6. HOW to go about getting an opinion

Once you know which surgeon(s) you’d like to consult with, it’s time to schedule an appointment.

Contacting the office

When you call the office, you may be asked to provide information such as age, diagnosis, insurance, whether or not you are referred by another provider, and if you’ve had previous hip surgeries.

Some surgeons’ offices will get patients scheduled to be seen based on this information. Others may ask you to send records for the surgeon to review prior to making an appointment. This may be done so that the surgeon can decide ahead of time if they are the appropriate provider for you. This may also allow the surgeon to determine if there are additional providers you should see or additional diagnostics that should be performed before or during the visit.

Requesting and sending medical records

If the surgeon’s office wants copies of the medical record before the visit, here are some next steps that patients and families can take:

1. Make sure to get the name of the person you are speaking with.  This can be helpful if you have to call back with questions about the process.  Ask which records are important for the surgeon to have. Some offices will send you an email detailing their requirements of records to send to them. Ask for the address and individuals that the records should be mailed to. 

2. Ask how long it generally takes to hear back after you send them your records. Depending on how often surgeons review cases and/or whether or not they meet with other surgeons as a team to review cases, it may be several weeks until you hear form the office. Ask when it would be appropriate to follow-up with the office again if you haven’t heard from the office in the time they anticipate.

Gather all of your records, including clinic notes and procedure notes from surgeons, physical therapists, and other healthcare providers you have seen, as well as images and reports for any imaging or tests you have had including x-rays, MRIs, CT scans, and diagnostic injections. The process of gathering records can be time-consuming and sometimes frustrating, but patients have the right to have copies of their medical records and medical offices and hospitals can provide guidance on how to request and obtain these records. Some patients prefer to have copies sent directly to their home. This way they can have a copy for their own records, or so that they can make additional copies to share with other providers in the future. Other patients prefer to have the records sent directly to the surgeon they plan on meeting with.

Medical offices and hospitals often have patients sign forms to release their medical records directly to the patient or to the healthcare providers of their choice. Some offices charge a fee for CDs of medical images and/or for copies of their paper or electronic record.

It can help to have personal copies of records scanned and saved to your own computers so the information is organized and easy to access in the future. X-ray, MRI, and CT images can be downloaded and saved onto personal computers, as well. However, it is important to bring actual copies of your images to clinic appointments, since these often cannot be emailed or uploaded from flash drives. These records often include a lot of private personal and medical information, so make sure to store them in safe, secure places or files.

3. Once you receive your written records and imaging CDs, they can be mailed to the surgeon for review. It might be helpful to include a general cover letter that briefly describes your hip-related medical and surgical history. Patients may prefer to mail their records to the surgeons’ office in-person at the post office so they can request additional tracking options and confirm when the records have been delivered.

Scheduling your appointment and the actual day of the appointment

Here are some tips to make the most out of your appointment day:

  • Make sure to schedule your appointment on a day when you have plenty of time for travel, the actual appointment, and any additional tests or imaging the surgeon may want you to get while you are at their office. Ask how long you should anticipate being at the clinic or hospital the day of your appointment.
  • Write down a list of questions for the surgeon. This will help make sure you get all of the information from the visit that is important for you to make your healthcare decisions. These questions may be related to your diagnosis and treatment options, the surgeon and his training, and experience, and any other information that is important to you. The IHDI has a list of questions that may be a good start for patients preparing for an appointment:
  • It can be helpful to bring a family member or friend to take notes and help make sure you remember to ask all of your questions.
  • On the day of your appointment, don’t forget to bring a pair of loose-fitting shorts with no metal buttons or zippers. This will make it easier for the provider to examine you and won’t interfere with x-rays. Most offices can provide paper shorts if patients don’t bring their own.
  • Make sure to get the contact information for who to reach out to if you have follow-up questions or need to make future appointments.

Contributed by Sarah B.

*The process of getting a second opinion varies among different healthcare systems, and this piece was written with the United States system in mind.  Hopefully the information provided can be of assistance for patients around the globe.