A second opinion on your health check results

When a second view helps

A second view helps most when a health check leaves you with a long report and more questions than answers. Typical reasons are a page of flagged blood results, a scan that mentions something nobody explained, a recommendation for further tests or treatment, or a report sent without a doctor to talk it through.

Second opinions often confirm the first, and that confirmation has value of its own. A systematic review of 33 studies of second opinions that patients sought for themselves found that many confirmed the original diagnosis or treatment, while differences between opinions could have a major effect on outcomes in up to 58% of cases, varying widely by specialty [1].

What general health checks can and cannot show

A broad health check is a snapshot, and its value depends on which tests fit your age, history and risk. A Cochrane review of 17 randomised trials, with outcome data on 251,891 people, found that general health checks offered to unselected adults had little or no effect on total mortality or cancer mortality [2].

That does not make every test useless. Blood pressure, cholesterol and diabetes risk are worth knowing, and some screening is recommended by age. It does mean a longer list of tests is no guarantee of better care. The UK National Screening Committee asks that the benefit of screening should outweigh harms such as overdiagnosis, overtreatment, false positives, false reassurance and uncertain findings [3].

Why healthy people have flagged results

A result outside the reference range is a prompt to look closer, and on its own it is rarely a diagnosis. Laboratories usually set the range as the central 95% of a healthy reference population [4], so about 5% of results from healthy people fall outside it by design. The more tests on a panel, the more likely it is that one or two will be flagged by chance.

A doctor reads each flag in context. A slightly high liver enzyme after a weekend of exercise, or a low vitamin D in winter, means something different from the same number with symptoms or a trend over several years. Bringing earlier results lets the doctor see that trend.

Unexpected findings on scans

Scans often find something that was not being looked for, and most of these incidental findings are harmless. An umbrella review in the BMJ found incidental findings in 22% of brain and spine MRI scans, and in more than a third of cardiac MRI and some chest CT scans [5]. Fewer than 5% of incidental findings in the brain and adrenal glands were cancers, though the rate was higher in some other organs such as the breast and thyroid [5].

A second reading helps decide which findings need follow up, how soon, and which can be noted and left. Ask for the original images as well as the written report, so a radiologist can look at them afresh if needed.

What to bring to the appointment

Bring the full report, with every value, its units and its reference range, as well as any summary. If the clinic that did the check has not sent everything, you have a right to ask for copies of your information, and organisations usually have one month to respond [6].

• The complete report with every result, its units and its range
• Scan images on a disc or a secure link, with the radiologist’s report
• Any letter or plan the health check gave you
• Earlier results, so the doctor can see a trend
• A list of your medicines and supplements with doses
• Your family history of heart disease, diabetes and cancer
• The two or three questions that matter most to you

Who it suits and who it does not

It suits you if your report raised a question nobody answered, if you were told to have further tests or treatment and want to be sure first, or if you want one doctor to keep your results together over the years.

It is not the right route for new or worsening symptoms, which need a doctor promptly. If you have chest pain, sudden breathlessness, signs of a stroke or severe bleeding, call 999 in the UK or the local emergency number. A second review can also lead to repeat tests or a referral, which take time and may bring their own uncertainty before they bring an answer.

Questions to ask the doctor

Take these to the appointment, so the time goes on what matters to you.

• Which of these results matter for me, and which can I leave?
• Does anything need repeating, and when?
• Is there a finding that needs a specialist, and how soon?
• Which tests from this report are worth doing again, and how often?

How The Wellness can help

A GP appointment of 30 minutes is £150. Send your report ahead, and the doctor goes through each finding with you and writes down what to repeat and what can be left alone. If a specialist is needed, navigation is £295 a case, and a first appointment is offered within 48 hours when it is urgent and within 5 working days when it is routine [7]. The consultant and any tests are billed by the people who do them, and you hear each fee before you agree [7].

Navigation is included in membership [7], and every doctor who sees a member reads the same record, so results from any clinic sit in one place [8]. Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open from seven in the morning to nine at night every day. Every doctor is GMC registered, and regulated services are delivered through registered partner clinics and accredited laboratories.