l You don’t have confidence in your doctor. Avitzur found that patients are less likely to follow a course of treatment when it’s prescribed by a doctor they don’t trust anymore. She sends her own patients for second opinions when she knows she’s not getting through to them. For example, a patient she strongly suspected had multiple sclerosis was clearly – and understandably – resisting the diagnosis. Because the disease might progress without treatment, Avitzur suggested the patient seek a second opinion from a specialist at a university medical center. It helped reassure her that medication was warranted, and she’s now doing very well with treatment.

l You think there might be other treatments. if your doctor tells you there is only one course of action, it should raise a red flag. That’s what happened to a physician who developed a painful kidney stone. His first doctor told him that if the stone didn’t pass in a month, he could have a procedure in which it would be removed through an endoscopic tube. When he sought a second opinion at another medical center, he learned he was a good candidate for extracorporeal shock-wave lithotripsy, a less-invasive treatment that uses sound waves to pulverize the stone and allow it to pass. the first doctor hadn’t even mentioned this idea, which may or may not have been related to the fact that his center didn’t own a lithotripsy machine.

l Your doctor dismisses your concerns. one individual developed recurrent bouts of vertigo, but her family doctor said that nothing was wrong with her and that her symptoms were due to the stress of her mother’s recent death. a second opinion uncovered an inner-ear disorder that promptly improved with vestibular rehabilitation therapy. you know your body best, and if your doctor doesn’t take your symptoms seriously, see someone else.

l You’re not getting better. this is the most common reason patients seek a second opinion. Medicine is as much an art as a science, so a fresh viewpoint might make all the difference if you’re not recovering from an illness or surgery at the pace you expected. the amount of time a doctor spends with a new patient is two to four times as long as a follow-up visit, so not only will you get a new perspective but also more attention.

l Your doctor recommends surgery. an astute orthopedist recently asked Avitzur to see a woman with a foot drop (the inability to raise the front part of the foot) after another neurologist had referred her to him for surgery. She repeated the muscle and nerve tests and, as the orthopedist suspected, concluded that surgery was the wrong course of action. Anytime your doctor recommends elective surgery to correct such ills as back pain, cataracts, gallstones or a hernia, consider a second opinion.

l Your condition is uncommon. some conditions are so rare that a primary-care physician encounters only one or two cases in a career. It’s worthwhile to consult a doctor at a major medical center with expertise in cases like yours. you can find more information on rare diseases from the National Institutes of Health (https://rare diseases.info.nih.gov/gard) and from the National Organization for Rare Disorders (rarediseases.org).

(c) Copyright 2010. Consumers Union of United States Inc.