Most people who come to us for a second opinion do not need a new medication. They need a better diagnosis.
In psychiatry there is no blood test or scan that settles the question; the diagnosis is a clinical judgment, and it is only as good as the time and method behind it. A diagnosis made in a 15-minute visit and carried forward for years, through six medications that each “didn’t quite work,” deserves to be examined from the beginning. That is what a second opinion at Cognitive Works is: a fresh, systematic evaluation by a psychiatrist who is not invested in the previous answer.
Every evaluation at Cognitive Works is conducted through the four psychiatric perspectives developed at Johns Hopkins by Paul R. McHugh and Phillip R. Slavney: disease, dimension, behavior and life story. The question is never only “which disorder,” but “what kind of problem is this”: an illness of the brain, a vulnerability of temperament, a behavior that has taken on a life of its own, or a response to what has happened in a life. Treatment that fails is often treatment aimed at the wrong kind of problem.
A 90-minute evaluation by video, with your records reviewed beforehand. We go through your history from the start, not from your last diagnosis: every episode, every treatment and what it actually did, your medical history, substance use, sleep, family history and the course of your life. Where it helps, we add pharmacogenomic testing. You leave with a written formulation: what we think is going on, what we think is not, and a specific treatment plan you can take back to your own clinician or continue with us.
Cost and insurance. Covered by the plans we accept as an evaluation visit; self-pay rates are published on our insurance page, where you can also verify your benefits in real time.
No. A second opinion is a consultation. You receive a written formulation and plan, and you decide whether to take it back to your own clinician or continue with us. With your consent we send the written report to your referring clinician as well.
Whatever you have: prior evaluations, discharge summaries, medication lists, therapy notes, lab results. We review everything you send before the visit; there is no limit.
Yes, and that is a useful result. Confirmation from an independent evaluation lets you commit to a treatment plan with confidence instead of doubt.