DEAR DOCTOR K:

Do you recommend getting a second medical opinion? I don't want to offend my doctor or make her angry. But with big health decisions, I'd like the extra input. What is the best way to proceed?

DEAR READER:

Most of us will face at least one important medical decision in our lives. It could involve whether to have surgery, or to undergo a diagnostic procedure that contains risks. Maybe you just feel that you don't really understand how you should be thinking about your options, based on the discussion with your doctor.

When you are not sure of what to do, getting a second opinion before starting treatment is a good idea.

A second opinion may simply confirm your first diagnosis or treatment recommendation. If it does, it doesn't mean it was a waste. If the two opinions agree, it can be reassuring about your diagnosis or treatment choice.

In some cases, a second opinion can be helpful just because another doctor may explain things in a way that's more understandable to you.

Sometimes a second opinion actually can improve the advice you get. Things in medicine are not always clear-cut, even to the best doctors. For example, consider a biopsy for something like a possible cancer. Your symptoms might suggest cancer. That spot in your lung on an X-ray might look like cancer. But the proof of whether a person has cancer is to get a sample of the tissue (a biopsy) that looks like cancer. Then experts look at the tissue under the microscope.

You'd think that the biopsy would provide a definitive answer. However, even something as seemingly straightforward as examining a biopsy can benefit from a second opinion. Research at Johns Hopkins found that second-opinion looks at tissue samples led to changed diagnoses in about 7 percent of the cases. Some went from benign to malignant, and some the other way around.

Second opinions can also save money by steering treatment away from expensive tests, medications or procedures. Some insurance companies actually encourage them, and some even require them in certain situations.

Still, you should check with your health plan before getting a second opinion to see whether the visit and any additional costs will be covered.

Asking your doctor, nurses, or family and friends for recommendations is a good place to start. Many hospitals offer second-opinion services, too.

There are also private companies that provide second opinions. But before choosing this route, do some homework to make sure it's a reputable business.

Your doctor shouldn't be offended or mad if you get a second opinion. In fact, if your doctor is put out that you want a second opinion -- one that could improve your health care -- perhaps she's not the right doctor for you.

A doctor giving a second opinion will want to see your records before offering an opinion. Call the office ahead of time to see what you should bring or have sent. And bring along a notebook so you can jot down notes.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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