Consider this situation ... your 6-year-old pet has been to the vet 3 times in the past 2 months for a chronic GI problem. There is no clear diagnosis nor improvement to anything that has been prescribed. You feel badly for your pet and are growing frustrated - at this point, you feel like you're spinning your wheels in mud and the vet bills are racking up. You start to wonder if it's time to seek a second opinion. 

Many pet owners feel that a request for a referral to a specialist will be offensive to their trusted, primary care vet. Just remember, you are your pet's primary advocate! It's no different than caring for a child or any other person for whom you have health care guardianship. So, asking your vet for a referral to a veterinary specialist is a common-sense next step, just as it is in human medicine. Veterinary specialists work in partnership with pet owners and their primary care vet to offer advisement and, in many instances, perform tests or procedures that are not available in a general veterinary practice setting.

In addition to second opinions that can be offered by specialists in internal medicine, cardiology, surgery, and ophthalmology (among others), second opinions may be sought when a biopsy is performed and test results reported. In humans with suspected cancer, second opinions on biopsies are standard practice because many studies have found the rates of discrepancies in diagnosis, and thus treatment, to be significant. In addition, studies have shown that the cost of second opinions is typically minor and can help to reduce the overall cost of care (e.g. avoid unnecessary tests / procedures).

Similar studies are few in number in veterinary medicine, but the results mirror those in human medicine. One study of second opinions (of biopsies in 430 cats or dogs) found diagnostic disagreement in 30% of cases, some disagreement in 20%, and complete disagreement in 10% of cases.

In another study, biopsies from 48 dogs and 4 cats were examined. Differences in cancer histopathology diagnoses were: 52% agreement, 29% partial disagreement, and 19% complete disagreement. The disagreements typically related to the degree of tumor malignancy, tumor type, and whether there was evidence of metastasis. Second opinions prompted changes in staging test recommendations (53%), treatment plan (100%), and prognosis (53%).

As the numbers of veterinary specialists increase, second opinions are becoming more common and the majority of primary care veterinarians welcome collaboration with specialists on difficult cases. The potential benefit of a second opinion to the patient is well demonstrated in human medicine and, increasingly so, in veterinary medicine - not only in terms of more accurate treatment and prognosis but also in potential cost savings.