What Is a Psychiatric Second Opinion?

A psychiatric second opinion is a consultation with a psychiatrist who is not your treating clinician, to review your diagnosis and treatment with fresh eyes. It does not replace your current care. Once the consultation is complete, most people continue with their own clinician, with a clearer picture of their situation and their options.

What questions does a second opinion answer?

A second opinion is built around specific questions rather than ongoing treatment. The most common ones are:

• Is the diagnosis correct, or is something being missed?

• Why has treatment helped only partly?

• Is every medication on the list still doing its job?

Does a second opinion usually change the diagnosis?

Not always. In a review of expert second opinions at a psychiatric clinic in England, most diagnoses stayed the same, but alternative treatment strategies were suggested (1). A second-opinion clinic in Australia that assessed complex and treatment-resistant cases revised the diagnosis in about half of the people it saw (2). Sometimes the diagnosis changes. More often, the plan does. And sometimes the result is confirmation that the current approach is sound.

Some conditions are known to take time to recognize. Bipolar disorder often appears first as depression. In a large survey of people living with bipolar disorder, 69% reported having been misdiagnosed at first, and more than a third waited ten years or longer for the correct diagnosis (3).

Is a second opinion disloyal to my current prescriber?

No. Second opinions are a routine part of medicine in every specialty, and physicians request them for their own patients. With the patient's permission, information can be shared in both directions, so that the conclusions reach the treating clinician.

How is it different from switching psychiatrists?

Switching moves ongoing care to a new clinician. A second opinion is a focused consultation with a defined end: it answers the questions, and care continues where it was.

What does a second opinion involve?

A thorough second opinion takes more time than a routine visit. It usually includes a full history, a review of past records, medications and lab work, and a conversation to explain the conclusions and the alternatives for treatment.

This post is general information, not medical advice. If you are in crisis, the 988 Suicide and Crisis Lifeline is available by call or text.

Sylvia Cartwright MD is a board-certified psychiatrist in independent practice in San Diego since 2013. She sees adults across California by telehealth. To learn more, visit https://www.sylviacartwrightmd.com/expert-second-opinion

Sources

1. Nirodi P, Mitchell AJ, Mindham RHS. Survey of expert second opinions in a tertiary psychiatric out-patient clinic in the Yorkshire region between 1988 and 2000. Psychiatric Bulletin. 2003;27:416-420.

2. Wallace et al. A military second opinion mental health clinic. Journal of Military and Veterans' Health. July 2015.

3. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161-174.