How to Ask for a Second Opinion: A Plain-Language Guide

Asking for a second opinion is a normal part of cancer care. It is not a complaint about your doctor. The National Cancer Institute describes getting one after a cancer diagnosis as very common, and says most doctors welcome it. The American Cancer Society says the same thing in plainer words: it is common, and the decision is yours. Many insurance companies pay for a second opinion. Some require one before they will approve payment for treatment, particularly for surgery.

You are allowed to ask. It is expected.

Most people who skip a second opinion do not skip it because of cost or distance. They skip it because they like their oncologist. Or because they are frightened of being seen as difficult by the one person they are counting on. That worry is understandable, and it is almost always misplaced.

Your oncologist has been on the other side of this conversation many times. Sending records to a colleague is routine paperwork for their office. The American Cancer Society notes that some doctors are more open to the idea than others. It also notes that the choice belongs to you either way.

Be clear about what you are actually asking for. You are not asking anyone to prove they were wrong. You are asking for a second set of eyes on a decision that will shape the next year of your life.

The American Cancer Society lists situations where a second opinion is especially valuable:

• The cancer is rare or unusual.
• The diagnosis or the stage is uncertain.
• Your doctor is not a cancer specialist.
• There is more than one reasonable treatment option.
• You and your doctor are having trouble communicating.
• You want to be sure you have seen all your options.

Two more belong in the same spirit. The proposed treatment may be aggressive, or impossible to undo, such as removing an organ. Then the stakes justify one extra appointment. And the diagnosis may simply not fit the picture. If the story of your body and the story on the page do not line up, that mismatch is worth checking.

There is also a reason that needs no justification. You want to feel confident about what happens next. That is enough.

You do not have to invent the sentence. The American Cancer Society suggests wording like this:

"I'm thinking of getting a second opinion. Can you recommend someone?"

"Before we start treatment, I'd like to get a second opinion. Will you help?"

"If you had this type of cancer, who would you see for a second opinion?"

The last one is disarming, because it turns the request into a compliment. Say it plainly, without apology. Say it early in the visit, rather than on your way out.

Bring your original doctor into the process. The NCI advises involving them. Their office is what sends your medical records, test results and x-rays on to the second doctor.

The second doctor needs the same raw material the first one had:

• The pathology report from your biopsy or surgery
• The operative report, if you have had surgery
• The hospital discharge summary
• A summary of the treatment plan being proposed
• A list of every medicine you take, with doses
• Your imaging — the scans and x-rays themselves, not only the written reports, on disc or released through your patient portal

Ask your doctor's office or the hospital medical records department for copies. Start early. Assembling records takes longer than people expect, and it is the step most likely to hold up an appointment.

A second opinion on treatment is one thing. A second look at the tissue is another, and it matters more than most people realize.

A cancer diagnosis rests on what a pathologist saw under a microscope. Some cases are genuinely hard to call. The NCI says that a patient or a doctor can seek a second opinion on a pathology report from another pathologist, particularly when there is uncertainty about the diagnosis. Doing that means getting hold of the actual slides, or the paraffin block, from the pathologist who examined your sample. You can also get them from the hospital where the biopsy or surgery was done.

Many facilities offer this review, including NCI-designated cancer centers and academic institutions. Call ahead. The NCI advises checking availability, cost and how the material should be shipped before you send anything.

A re-review can confirm the original reading. It can also change it. It can change the type of cancer, the grade, and sometimes whether it is cancer at all. If a borderline result is driving a decision you cannot undo, this is the opinion to get.

For most cancers, there is time. The American Cancer Society says you can usually take the weeks a second opinion needs. For a few cancers, some treatment decisions have to be made right away.

You do not have to guess which situation you are in. Ask directly: "How much time do I safely have to arrange this?" Your doctor can answer in a sentence. That answer removes most of the pressure that makes people skip the step.

Second opinions come from hospitals, clinics and cancer centers. One good starting point is the network of NCI-designated cancer centers — 74 of them across 37 states and Washington, DC. The NCI lists them with contact details in its Find a Cancer Center directory. The American Cancer Society also points to the American Board of Medical Specialties, where you can check a doctor's board certification. Your own doctor's recommendation is a legitimate route too.

Distance is less of a barrier than it once was. Records and imaging travel electronically. Slides and blocks can be shipped. Many centers now consult remotely. The NCI includes telemedicine among the things worth asking a prospective doctor about.

Call your insurer before you book. The American Cancer Society advises checking your policy first. Some plans require the second opinion to come from an in-network provider before they will approve payment for treatment. Ask what is covered, whether you need a referral, and whether the center you have in mind is in network.

• National Cancer Institute — Finding Cancer Care (including second opinions)
• National Cancer Institute — Pathology Reports Fact Sheet
• National Cancer Institute — NCI-Designated Cancer Centers
• American Cancer Society — Seeking a Second Opinion