What should a written second opinion answer?
A printable question sheet for understanding the scope, reasoning, alternatives and unanswered questions in a written medical opinion.
A useful written opinion explains what was reviewed, what the reviewer thinks, why, and what still needs clarification. Agreement with the first clinician can be a useful result. A different answer is not, by itself, evidence that the second opinion is better.
This question sheet helps you prepare a discussion with the reviewing service. It is not a mandatory reporting standard, a way to score clinicians, or a substitute for an appointment. Ask your treating clinician about timing; do not postpone urgent care while waiting for a document.
Start with the decision you face
Write one sentence: The decision I need help understanding is ______. A question about whether to have a procedure is different from a request to interpret an image or check a diagnosis. Confirm which question the service has agreed to address, whether it reviews records alone and whether an examination is needed.
The National Cancer Institute describes second opinions in cancer care as another specialist reviewing the case materials; the recommendation may agree with or differ from the first. Its guidance concerns cancer care, not every specialty's review process.
Read the opinion with these six questions beside it
Print this page or copy the blank fields into your private notes. You do not need to subscribe to use it.
| Question to clarify | Where the opinion answers it, or what to ask |
|---|---|
| What question was the reviewer asked to address? | ______ |
| Which records, images and dates were reviewed? | ______ |
| What is the recommendation, and what supports it? | ______ |
| Which alternatives were considered, and why? | ______ |
| What missing information or uncertainty could change the answer? | ______ |
| Who discusses next steps with me, and when? | ______ |
An empty field means a question to resolve. It does not prove the reviewer overlooked it: the answer may be in a consultation, a separate report or outside the agreed scope. Keep those distinctions visible.
Look for the reasoning, not just the conclusion
Ask how the recommendation relates to the problem you want addressed and to the priorities you have described. NICE's shared decision making guidance supports discussing options, their consequences, personal priorities and uncertainty. It does not prescribe this worksheet or a universal format for second opinions.
Useful follow-up questions include:
- Which finding carries the most weight in this recommendation?
- Is the answer conditional on information you have not yet received?
- What other reasonable options should I discuss with my treating clinician?
- What would make you reconsider this recommendation?
Do not treat a cited paper as a complete explanation. Ask how its findings apply to the decision and circumstances under discussion.
Finish with an owner for the next conversation
Record the service's contact for questions, the clinician who will coordinate your continuing care and the timing you have been advised to follow. A written opinion may have a limited remit; ask who will explain it and help with a treatment plan rather than assuming the document transfers responsibility.
For the submission itself, use what to prepare for a second opinion. If the recommendations differ, use the disagreement comparison sheet to organise the questions without choosing a winner yourself.
Compare the written scope before applying
Keep the proposed report, clarification and ongoing treatment as separate questions. A service that offers one clarification is not necessarily offering repeated consultations, a new diagnosis from an examination or continuing clinical care. Ask for the named medical provider, report language, delivery conditions, exclusions and cancellation rules before agreeing to proceed.
For a concrete external commercial example, NEXA’s published second-opinion scope describes one main medical question, relevant existing records, a written specialist report and one clarification within the agreed scope. It excludes video consultations, new tests, prescriptions, ongoing treatment and separate imaging or pathology re-interpretation by default. As checked on 19 October 2026, applications are open but payment is not; the provider and service terms still need confirmation. Use the description to identify questions to ask, not as a universal reporting standard, a guarantee of availability or an independent endorsement of the provider.
Core sources checked on 12 October 2026; the external service scope was checked on 19 October 2026. The sheet is an original editorial aid, not a validated clinical decision instrument or licensed clinical review.
Sources
Take these questions to your clinician. The options guide can help you organise a discussion about benefits, uncertainties and alternatives.