taking second opinion

Taking a second opinion? Here’s what you need to know


Following the paradigm that two eyes are better than one, many healthcare systems and patients prefer to get a second opinion nowadays, especially before undergoing surgery or procedure that is known to have some risks or serious side-effects. In fact, the Massachusetts state made it mandatory way back in 1970’s to obtain a second opinion before any elective surgery. [1, 2]

Previous studies have found that getting a second opinion has several advantages. First, as a result of taking a second opinion, the patient may sometimes become aware of an alternative treatment approach. This is due to the result of the diagnostic variations between independent physician reviewers. Greater patient awareness is also known to encourage improved patient to physician communication [3], which inevitably leads to other benefits such as discussion on available treatment options, expectation setting after surgery. With the mounting cost of healthcare procedures involving surgery, getting a second opinion has become a wise choice, not only for patients but also for healthcare insurance providers.

A most typical scenario for a patient to take the second opinion involves sharing of available medical reports as well as sharing information about the previous opinion received. In certain cases, the second opinion giver may also suggest few additional tests. A patient is also more likely to take a second opinion when the prior opinion suggested a more interventional treatment such as a surgery.

An interesting study [4] was carried out in Israel in 2011 to assess how a physician’s judgment can get influenced by the knowledge of the previous opinion. This study analyzed this question for doctors in orthopedics and neurology. A total of 172 orthopedic surgeons and 160 neurologists were included in the study sample. The sample included physicians forming a right mix of experience ranging from residents, seniors with 7 years or less surgical experience and doctors for over 7 years and above experience. The sample also included doctors from both within Israel and other countries.

Eight medical scenarios were created for each set of specialty. Each scenario was selected and designed in a way that represented the dilemmas surgeons would come across in a real world situation. In each scenario, a few options were listed for the surgeons to select, as what he or she considered the best alternative to treating the patient. As is typical of such studies, a group of surgeons would form a control group, which had the same information presented, except for information on the previous opinion. Physicians were selected on a random basis for each group to eliminate any other effects such as seniority, the location of the doctor, affiliated hospital, etc.

Findings of this study demonstrated that awareness of the previous opinion which suggested a more interventional treatment like surgery resulted in shifting of second opinion giver towards suggesting a similar approach. Interestingly, this was more clearly pronounced in the case of orthopedic surgeons, whereas neurologists did not seem to get biased by previous opinions!

It is documented in several studies that surgical judgment can differ radically from one surgeon to the other. The variations become more pronounced in the case of elective surgeries. In some instances, an interventional approach such as surgery has been found to be unnecessary. At the same time, empirical research indicates that medical complications could be avoided by undergoing surgery than delaying it. What is beyond any doubt though it that when the opinions differ between two or more physicians, patients are never at a losing end. Instead, they become more highly aware of the multiple options and the associated advantages and disadvantages of each [5].

What is quite insightful from the above study is that to gain the maximum benefit from a second or third opinion, it is best for the patient not to share the prior opinion received. Even though it may be hard to do in practice, the best outcomes from a second opinion would come when the physician analyzes your cases without any bias. Instead, a better approach is to take independent opinions from a few doctors. If there are divergent views, then discuss those with the surgeons whom you trust the most and have a level of comfort to share different opinions. This would ensure that while initially you get as many independent opinions on your case, finally all of the available information is processed to decide the best course of action for your treatment.

While it is best to share what is necessary for a medical opinion such as your medical reports, medical history, etc. and withhold the prior opinion received, in practice, it is hard to follow. Usually, a patient who has been advised surgery is highly likely to share his or her concerns that surgery has been advised and ask questions on whether it is avoidable, etc. The body language too can easily reveal that the patient is under anxiety because he or she has received such advice. This is where, and only for certain specialties, online methods of taking a consultation can come extremely handy. As a patient, you could make all the necessary reports available along with your questions for an online consultation, and receive an opinion that is strictly based on the furnished medical information. Subsequently, if you get a divergent view, you are more well-equipped than before to discuss your case again with your primary doctor or surgeon.

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References:

  1. Gartman PM, Stackpole DA, Levenson DK, Manuel BM, Brennan RJ, Janko GM. Second opinions for elective surgery. The mandatory Medicaid program in Massachusetts. N Engl J Med. 1980: 302(21):1169-74
  2. Althabe F. Belizan JM, Villar J. et al. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomized controlled trial. Lancet. 2004:363(9425):1934-40
  3. Goldman RE, Sullivan A, Back AL, Alexander SC, Matsuyama RK, Lee SJ. Patient’s reflections on communication in the second opinion hematology-oncology consultation. Patient Educ Couns 2009:76[1]:44-50
  4. Do First Opinions Affect Second Opinions? Geva, Vashitz; Joseph, Pliskin; Yisrael, Parmet; Yona, Kosashvili; Gal, Ifergane; Journal of General Internal Medicine , Volume 27 (10) – Oct 1, 2012
  5. Vlerhout WP, Knottnerus JA, van Ooij A. et Al. Effectiveness of joint consultation sessions of general practitioners and orthopedic surgeons for locomotor system disorders. Lancet. 1995:346(8981):990-4
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