Developmental Services - Case Management Manual

Obtaining a Second Opinion

Second opinions can be extremely useful in helping the consumer and/or family make informed decisions about medical and other types of treatment. There are two situations where second opinions should always be obtained. 

These are:

  1. When elective surgery is recommended for a consumer under public guardianship, and,
  2. When a recommendation is made for "no code" or "no heroics" status for a consumer under

Public guardianship. 

For consumers who have a private guardianship, the Case Manager should pursue a second opinion in both situations noted above.

There are a number of other kinds of situations where a caseworker should consider requesting another opinion. Some examples of instances where another opinion should be considered are:

  • When radical surgery is recommended, i.e., removal of limb, organ, etc.
  • when conflicting medical opinions are given regarding a course of treatment,
  • when consumer's medical problem is not resolved, i.e., uncontrolled seizures,
  • When consumer has received psychotropic medication over extended period of time, with no attempt at reduction/alterations in regime.

Non-Medical Second Opinion

There are also instances within other treatment modalities where second opinions can be useful. Some examples are:

  • when there are conflicting opinions about whether a person should be considered to have mental retardation,
  • Where there are conflicting recommendations from within a discipline or across disciplines, i.e., use of sign language vs. attempts at vocalization. 

The standard that should be applied in deciding whether to seek a second opinion is the standard applied to the general population. The caseworker should ask, "If I were this consumer, would I want another opinion?" It is equally important to examine the purpose of obtaining another opinion. The primary purpose should be to clarify a course of treatment or to assist in making a decision affecting a consumer. Second opinion should not be used to resolve unspecific concerns about physician or clinician competence.

Process for Obtaining a Second Opinion

In Most instances, the caseworker should approach the consumer's primary physician or clinician regarding the desire to pursue a second opinion about a particular issue. Getting agreement and cooperation will greatly enhance the chances of obtaining a meaningful and

comprehensive second opinion. Extending the courtesy of discussing a possible second opinion and providing a clear rationale as to why it is desired will hopefully ensure needed cooperation. The person being asked to give the second opinion also needs to be informed about the rationale and about whether the primary physician concurred or not with the solicitation of a second opinion.

Once the second opinion has been obtained, the caseworker should assure that there is clear documentation in the consumer's record about the outcome and course of treatment.