The Power of A Second Opinion

The Power of A Second Opinion by Dr. Nancy Palermo Lietz, MD

Caroline was a healthy 46 year old diagnosed with breast carcinoma in situ following a radiology biopsy done after an abnormal mammogram. As with many women, she was eager to proceed with treatment and was quickly referred to a surgeon through her primary care with no forethought or research on treatment options.  She was quickly scheduled for a lumpectomy and node biopsy only to find out a month later that the cancer was more advanced and she would require further surgery and treatment. A review of the pathology from the first surgery confirmed an invasive high-grade cancer that would have been better treated with mastectomy, chemotherapy and postoperative radiation. Performing the incorrect surgery only delayed treatment and added more pain and confusion to an already stressful situation.

Caroline is like many patients in that she did not consider a second opinion prior to her surgery. In fact, only one in every five patients seeks a second opinion. This number is fairly constant even when the diagnosis involves cancer or a complicated or serious diagnosis. A 2015 study in the American Journal of Medicine, reviewed the outcomes of a National Patient Initiated Second Opinion program from Best Doctors, Inc. It revealed patients only sought second opinions in about 20% of cases. When they did it was most commonly related to treatment options ( 41%) and diagnostic concerns ( 35%). The study found that second opinions resulted in changes in the diagnosis or treatment 41% of the time.

Patients generally don’t seek a second opinion because they do not want to upset their current physician or they are eager to proceed with treatment. Many patients are also concerned that a second opinion will be an extra cost to them. The reality is most Insurance Companies encourage second opinions and the majority covers the cost fully. The more complicated or serious the condition the more useful a second opinion may be, especially given data suggesting differing opinions.

Many of the top medical centers like Cleveland Clinic, Johns Hopkins and MD Anderson offer remote consultations pending the review of a patient’s record.  These specialists require a close review of all of the patient’s medical record including physician notes,  x-rays, lab tests, and pathology. Additional testing should not be necessary unless an inadequate initial workup was done. When such consultation is made it often is provided by a specialist in the field. The second set of eyes, especially expert eyes can only be beneficial. Even when the experts agree with the initial physician the patient is offered significant peace of mind.  Many of these remote consults are covered but they may cost the patient up to $1500 in out of pocket costs.

Getting a second opinion does not require the patient to change their physician or accept the advice or treatment of the new physician. Only 61% of patients ultimately proceed with the advice given in the second opinion.  Even when the experts agree with the initial physician the patient is offered significant reassurance and peace of mind.

When a patient is faced with a confusing, complicated or serious diagnosis a second opinion can serve to optimize outcomes and further educate the patient on their situation. An informed patient is always better off in the long run.

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