Second opinion: when can a second medical opinion be sought?

If you as a patient seek a second opinion before a possible operation, you have a better basis for making your decision. That is not only important because different doctors often have different points of view, but also because the right decision about surgery does not just depend on the doctor’s expertise. Your particular personal situation and needs are important.

If you have statutory health insurance, you are entitled to seek a second opinion before certain operations that can be scheduled. The Health Care Strengthening Act (GKV-Versorgungsstärkungsgesetz) of 2015 created the basis for that. The new so-called structured second opinion procedure was introduced in 2019. The health insurance provider assumes all the costs involved.

The doctors who are visited first are described in this procedure as first opinion doctors. The doctors who are meant to submit the second opinion are called second opinion doctors.

The second opinion procedure should give patients more certainty in assessing whether a scheduled operation is medically necessary. Furthermore, there are multiple treatment options for many diseases, and each of these therapy options has their pros and cons. The second opinion should help people make the right decision for them. This decision depends not least on the personal situation and individual requirements.

Moreover, comparisons have revealed that doctors give very different advice and also often represent different points of view. So for example, one doctor may clearly advise quick surgery, while another may be more cautious. But both may have good reasons for their respective positions.

It should be added that some patients shy away from questioning medical recommendations. The second opinion procedure offers you the opportunity to get detailed information and compare the respective arguments.

The Federal Joint Committee (G-BA) decides which operations the second opinion procedure can be claimed for. This committee also establishes which guidelines apply to the second opinion and which requirements doctors must comply with as so-called “second opinion doctors”. One such requirement is that the second opinion doctors should be long-standing specialists in the applicable field.

The new procedure for obtaining a second opinion applies at present to the following operations:

• hysterectomy
• tonsillectomy
• arthroscopy of the shoulders
• knee joint replacement
• amputation of a diabetic foot
• certain types of spinal surgery

If your doctor recommends one of these operations, they must point out the option of the second opinion procedure. To help you prepare for seeking a second opinion, there is a patient fact sheet and information documents about the individual operations (decision aids) that your doctor must also point out to you. 

If a doctor has recommended one of the aforementioned operations to you, you generally have to be informed at least 10 days before the scheduled operation that you have a right to a second opinion.

If you would like to make use of this opportunity, you must contact a doctor who is authorized for the structured second opinion procedure. A list with authorized doctors is available on the German-language Patient Service website published by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung – KBV). But you can also make a request to your health insurance provider at any time.

To the website “Der Patientenservice”

The doctor who is meant to give a second opinion requires your current documents like diagnostic findings and examination results. You can take the required documents with you from your first medical practice. Or you can have them sent directly from there to the second medical practice. Both options are free of charge for you.

As a general rule, the so-called “second opinion doctor” does not perform all examinations again, but in particular reads your documents and asks supplementary questions. However, if other examinations are a good idea, the doctor will discuss that with you.

If the doctor has reappraised and checked your case, he or she will provide the second opinion and discuss the recommendation with you. You are free to have the scheduled operation performed or to cancel it. You can get a written summary of the second opinion on request. You can also have the second opinion sent to your first doctor.