A second opinion means asking a doctor other than your current primary doctor (a specialist) for an opinion about the diagnosis or treatment plan. It is a system that supports decision-making based on enough information1).
It is not a sign of distrust in the primary doctor, but a process for making decisions based on enough information. As a result of a second opinion, the primary doctor’s plan is often supported, and reports show that patients feel more reassured and become more willing to take part in their treatment5).
Medical fee evaluations and usage surveys have been carried out1), and university hospitals and specialized hospitals are increasingly setting up second-opinion clinics.
What is a referral letter (medical information letter)?
A referral letter (medical information letter) is a document in which the primary doctor records the patient’s diagnosis, treatment history, test data, and medications. It is used to help care continue smoothly when visiting another medical institution.
QIs a second opinion different from transferring to another hospital?
A
A second opinion is meant to hear another opinion, and it is different from transferring care (changing medical institutions to receive treatment). Even after getting a second opinion, there is still plenty of room to continue treatment with the original primary doctor. The real purpose is to use it when you want to refer to another specialist’s opinion.
2. Situations in ophthalmology where a second opinion is especially useful
Retinal detachment: choosing the procedure, scleral buckling vs. vitrectomy
Glaucoma: the limits of eye drops and when to consider surgery (trabeculectomy, MIGS, etc.)
Strabismus (children): the right timing and method for surgery
Before surgery that has a major impact on visual prognosis, it is reasonable to hear opinions from several specialists.
Intractable and rare diseases
Uveitis: there are many possible causes (sarcoidosis, Behçet’s disease, Vogt-Koyanagi-Harada disease, etc.), so evaluation at a specialized center is useful
Treatment-resistant age-related macular degeneration and diabetic macular edema: considering switching anti-VEGF drugs or steroid treatment
For rare diseases where there is no specialist in the region, a second opinion from a university hospital or specialty center can sometimes become a turning point in diagnosis and treatment8).
After a serious diagnosis
Eye tumors: In conditions such as choroidal melanoma and retinoblastoma, it is especially important to confirm treatment options such as radiotherapy and enucleation
Conditions directly affecting visual prognosis: When receiving serious news, hearing another specialist’s opinion strengthens the basis for decision-making
Reports suggest that a second opinion can reduce patient anxiety and lead to more active involvement in treatment6).
QWhen should you get a second opinion in ophthalmology?
A
The main typical situations are the following three: ① when you are unsure whether surgery is needed or which surgical method to choose, ② when you are not confident about the diagnosis or treatment plan for a refractory or rare disease, and ③ when you receive a serious diagnosis such as an eye tumor. When questions such as “Is surgery really necessary?” or “Is there another treatment?” come to mind, that is a sign to consider a visit.
Say frankly, “I would like to hear another specialist’s opinion as well.”
Ask your attending physician to cooperate with providing medical information
Example phrasing: “It’s not that I’m dissatisfied with your treatment plan, but I would like to also consider another doctor’s opinion about the decision on surgery. Could I ask you for a referral letter?”
Step 2: Prepare referral letter and required documents
Under insurance-covered care, the medical information provision fee (250 points) is billed, and with a 30% copay the out-of-pocket cost is about 750 yen3)
A separate copying fee may be charged for test images (fundus photos, OCT, etc.)
Differences depending on whether you have a referral letter
First visit without a referral letter to a university hospital, etc.
None
Additional fee of 7,000 yen or more + insured medical care
Revised in October 2024
Direct visit to a small or medium clinic
Not required
Insured medical care
The level of specialization is more limited than at a university hospital
QCan I get a second opinion without a referral letter?
A
At small and medium-sized ophthalmology clinics, you can be seen even without a referral letter. However, at university hospitals and designated functional hospitals, a separate selected medical care fee applies for a first visit without a referral letter (from October 2024, 7,000 yen or more in medical care)3). With a referral letter, the course of treatment is communicated accurately and a more efficient consultation is possible, so bringing one is strongly recommended when using a second opinion clinic.
If you are visiting for a “consultation and examination at the referral destination” rather than a second opinion, it will be covered by insurance.
In addition to the initial or follow-up consultation fee, various test fees will be charged
If you have a first visit without a referral letter, a separate selected medical care fee applies at designated functional hospitals and regional medical support hospitals3)
Treatment glasses for children under 9 with amblyopia, strabismus, or after surgery for congenital cataract are covered by health insurance 4). The maximum benefit amount is 38,902 yen for lenses and 8,349 yen for frames, and the insurer pays this as medical expense reimbursement.
A second opinion is a way to make informed consent (providing enough information and obtaining consent) truly effective. It supports the process of comparing several explanations and choosing a treatment plan with confidence 1).
When patients choose a treatment plan based on the opinions of multiple specialists, they can make decisions with greater confidence
It has also been shown that many patients support the primary doctor’s plan after getting a second opinion, which can help strengthen trust 5)
A second opinion is not a sign of ‘distrust’ toward the primary doctor. Many doctors take patients’ wish for a second opinion positively, and there is a willingness to respect discussion among specialists 7). The second opinion often complements or supports the primary doctor’s judgment 8).
“Doctor shopping” refers to going from one doctor to another repeatedly without a clear purpose. It is fundamentally different from a second opinion.
The purpose of a second opinion is to hear an expert’s view on a specific diagnosis or treatment decision
It assumes there is a primary doctor, and after hearing the opinion, it is important to report back to the primary doctor and use it in the final decision
A one- or two-time consultation with a specialist for a clear purpose is respected as a second opinion
“I would like to understand the surgery a little better, so may I also get another specialist’s opinion? Could you please provide a referral letter?”
“I understand your explanation well. I would like to receive a second opinion just to be sure, so I can move forward with treatment with greater confidence.”
Tattersall MH, Dear RF, Jansen J, et al. Second opinions in oncology: the experiences of patients attending the Sydney Cancer Centre. Med J Aust. 2009;191(4):209-212.
Hillen MA, Medendorp NM, Daams JG, et al. Patient-driven second opinions in oncology: a systematic review. Oncologist. 2017;22(10):1197-1211.
日本医師会. かかりつけ医機能とセカンドオピニオンに関する見解. 2015.
Payne VL, Singh H, Meyer AN, et al. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc. 2014;89(5):687-696.
Copy the article text and paste it into your preferred AI assistant.
Article copied to clipboard
Open an AI assistant below and paste the copied text into the chat box.
