Getting a Second Opinion in our Public Health System

When we hear stories about people’s experiences receiving a diagnosis like breast cancer, we often hear the empowering message to trust your gut and get a second opinion if the answers aren’t sitting well with you. These messages, while meant to be inspiring, can often feel impractical. In other countries, like the US, getting second opinions may be fairly straightforward, but in Canada, second opinions may be a bit trickier to come by.  

Our public health system offers a lot of financial assurance. We don’t have to worry about paying for costly medical bills when we see our doctors or take a trip to the emergency room. And we don’t have to worry about paying for most* of the standard breast cancer treatments. But when we are uncertain about a diagnosis or a treatment plan, getting a second opinion may feel daunting and uncomfortable.

Who to ask when requesting a second opinion
Getting an appointment with a specialist requires a referral from another physician. The first step is to talk to your family doctor and ask for a referral. This conversation may be an easy or difficult one to have. If the second opinion you are seeking is about the decision or diagnosis made by your family doctor, it may be uncomfortable to go to them for such a request. But remember that if you truly believe you need another physician’s input, it’s an important discussion to have. Have a conversation with them. Be open and honest about your concerns and why you feel a second opinion is important. You can use tips from our Digital Advocacy and Storytelling Toolkit to help you frame your message when communicating your needs to your doctor.

According to the Canadian Medical Association’s Code of Ethics and Professionalism, physicians are to “respect the patient’s reasonable request for a second opinion from a recognized medical expert.”[i] This means that you have the right to a second opinion. Even seeking reassurance about a diagnosis can be considered a reasonable cause for requesting a second opinion. The Canadian Medical Protective Association believes that just because a patient is seeking a second opinion it “should not be interpreted as a breakdown in the doctor-patient relationship.”[ii]

Another option is to ask the specialist you have already seen for a referral to a second doctor. Another uncomfortable conversation may be had, but many specialists would hopefully understand your concerns about seeking additional input.

If you don’t have a family physician or cannot get a referral from one, you can seek advice from a doctor at a walk-in or urgent care clinic. While they will not have a complete history of your health, you may be able to explain your circumstances and reasoning for a specialist referral. Make sure to bring along any documents or results you may have so that the doctor has as much information available to make an informed decision about referring you.[iii]

Finally, you may be able to reach out to your private insurance company to see if they have the capacity in your plan to refer you to another specialist for a second opinion.[iv]

If you’re successful in getting a second opinion, you may want to come prepared with a name of a physician that you would like to be referred to. Reach out to friends, peers or other patients that you may connect with through support groups to see if they know of a particular specialist they recommend. The recommended physician may not be available to see you, but it is helpful to try.

Going to your second opinion appointment
Once you have your referral, it may take time to get an appointment to see the specialist. You may receive the same diagnosis or treatment options, or you may be given a different set of options. If you’re able, try to record the session on your phone. This may help if there is a discrepancy between the recommendations made.

If the recommendations are the same, it might give you some reassurance that you are on the right path. But having conflicting options may leave you more confused. It’s always important to ensure that results or recommendations from the second opinion are shared with your primary care team (whether that be your family doctor or the main specialist). Speak with your family doctor or with the original specialist about these options to help you decide what path to take.

Gaining a second opinion will require self-advocacy on your part. Use your voice and advocate for what you feel is necessary and important.

* Not all breast cancer drugs are publicly funded by provincial governments. Access to certain breast cancer drugs in Canada can be largely dependent on where a person lives. This forces many patients to jump through hoops to find supplemental funding for their treatments or find alternative ways to cover these costs like paying out of pocket. Read our post on ways to access funding for your treatments here.