Why second opinions are getting a second look

Experts say hard data lacking on quality outcomes of follow-up opinions

Although second opinions can be valuable to individuals looking for diagnosis confirmation or those weighing treatment options, many second opinions may not actually result in better outcomes, Michelle Andrews reports for Kaiser Health News.

A study by Best Doctors—a second-opinion service offered by some companies as an employee benefit—published this spring in the American Journal of Medicine found that about 35% of people chose to get second opinions after they received a diagnosis in order to identify information that may have been missed or misinterpreted during the initial diagnosis.

About two-thirds of these patients sought a second opinion because their symptoms had not improved, while the rest either had additional questions related to their original diagnosis or had not received a diagnosis at all.

In addition, the study found that more than 40% of the 6,800 second opinions studied resulted in diagnostic or treatment changes.

Another study published in Mayo Clinic Proceedings last year also found between 10% and 62% of second opinions spurred a major change in diagnosis or treatment. Experts estimate that diagnostic errors happen in 10% to 15% of cases.

However, despite the multitude of data encouraging patients to seek second opinions, little is known about whether such opinions actually lead to better health results, writes Andrews.

Hardeep Singh, a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, asks "What is the real diagnosis at the end? The first one or the second one?" And "maybe both are wrong," he adds. "What we don’t know is the outcomes."

In addition, patients that seek a second opinion may not heed that advice. The Best Doctors survey found that while about 95% of patients were satisfied with their experience, only 61% actually agreed or strongly agreed they would follow the recommendations they received from the second opinion.

The many faces of a second opinion

Meanwhile, getting a second opinion might not involve an actual face-to-face meeting with an alternate specialist, but instead could be as routine as a close examination of the patient's medical records by a different doctor in the community or elsewhere, Andrews reports.

In addition, some employer-based services, including Best Doctors or Grand Rounds, can give patients second opinion consultations online—but many of those services are not covered by insurance. For instance, the Cleveland Clinic offers the MyConsult service, which costs $565 for a standard second opinion and $745 for a consultation plus pathology review.

But, says Cleveland Clinic CIO C. Martin Harris, "It really does give people relatively easy access to expertise" (Andrews, Kaiser Health News, 5/26).

The takeaway: While experts agree second opinions can make a big difference in patients' diagnosis and treatment options, some say there is little evidence that alternate opinions actually result in improved outcomes.

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