HOW DOES A SECOND OPINION ADD VALUE TO YOUR MEDICAL DIAGNOSIS?
A second opinion involves obtaining another doctor's assessment of your medical condition in addition to the first diagnosis you received. It was first introduced in the United States in the 1970s because some health insurance companies noticed that surgery rates varied across different regions and wanted to ensure patients were making informed decisions. Over time, seeking second opinions has become common for other medical conditions, not just elective surgeries.
Medical second opinions can be classified into three main types. The first type arises when patients seek to validate the initial physician's recommended diagnosis, treatment, or prognosis. The second type occurs when physicians proactively seek the input of a second specialist. The third type relates to those typically enforced by third-party insurers, often referred to as prior authorization, affecting patients and doctors alike.
In this article, we attempt to shed light on patient-initiated second opinions, which can improve the accuracy of the diagnosis and treatment and may even prevent unnecessary surgeries.
The Emergence of Patient-initiated Second Opinions
Patients seek second opinions for various reasons, such as unresolved symptoms, dissatisfaction with their initial physician, seeking more information about their condition, or being diagnosed with a terminal illness such as cancer.
Studies have shown that about 1 in 6 patients have sought a second opinion within the past year, and even more cancer survivors have done the same. According to a report by market research firm, The Insight Partners, the global medical second opinion market is expected to reach $10.73 Billion by 2027, growing at a CAGR of 16.8% from 2020 to 2027.
However, despite the importance of patient-centered care and quality healthcare, there is very little scientific research available on this topic.
In Which Areas are Second Opinions Mostly Requested?
While second opinions are common in all areas, they are of particular importance in radiology and pathology. Many academic medical centers now require a second review of diagnostic reports from external sources. Studies have shown that there can be discrepancies in the initial diagnoses, which can have a significant impact on prognosis and treatment. For example, one review found major discrepancies in 0.6% of cases, affecting patient outcomes. Other studies have reported discrepancy rates ranging from 1.3% to as high as 36% in some cases.
According to a study by Boudali et al, 66% to 82% of patients seeking a second opinion were women who were recently diagnosed with breast cancer. On the contrary, patients with general medical issues often experienced long-lasting symptoms and had undergone long-term treatment before a second consultation. A majority of these patients suffered from rheumatologic, neurologic and gastroenterologic conditions.
Second Opinions on Cancer
A study by Mellink et al was conducted in a cancer clinic, observing 403 patients seeking a second opinion. 87% of them were women, and 83% of those patients had breast cancer. The review included an oncologist's consultation and a second reading of the diagnostic histologic, cytologic, and radiologic tests. There were no differences in treatment for 68% of the 317 patients whose second opinions could be directly compared with the first, minor discrepancies were noted in 16% of cases, and severe discrepancies appeared in 16% of cases which led to major changes in treatment and prognosis.
Second Opinions on Elective Surgery
4555 individuals participated in the Cornell Elective Surgery Second Opinion Program. The second surgeon deemed the elective procedures unnecessary in 34% of these patients. The majority of these cases involved orthopedic and gynecologic issues.
Patient-initiated Second Opinions: Impact on Diagnosis, Treatment and Patient Satisfaction
According to studies, nearly half (46%) of cancer patients sought a second opinion due to difficulty in treatment. A third (30%-38%) reported unmet demands and/or bad experiences, 27% reported communication issues with their initial doctor or desired a conclusive review due to the first diagnosis's perceived extremeness (32%).
Confirmation of a previously made diagnosis or diagnosis of yet unexplained symptoms were two prominent reasons for patients with general medical concerns to seek a second opinion.
Patient satisfaction with the first and/or second opinion was observed in five clinical trials. It was typical for patients to be unsatisfied with the first opinion, which led to their seeking a second one. Patient satisfaction in cancer patients was highly connected with assurance regarding the diagnosis and/or treatment plan, the doctor's demeanor, and the patient's participation in the decision-making process.
High Discrepancy Between the First Recommendation and Second Opinion
A study found that only one-third of initial therapy recommendations were confirmed by independent specialists, highlighting the importance of patient access to second opinions. The study found that patients were highly satisfied with the second opinion service, and most patients chose the therapy recommended by the second opinion.
While many second opinions confirm the original diagnosis or treatment, a significant percentage results in major changes. The proportion of patients receiving different advice on treatment compared to their diagnosis is also notable.
Mandatory second opinion programs have shown similar findings to voluntary patient-initiated second opinions. Disagreement rates for the need for elective surgery range from 20% to 40% in both types of programs. Higher discrepancy rates have been reported in specific fields like neuroradiology, trauma, and mammography.
Second opinions have the potential to reduce diagnostic errors, which are estimated to occur in 10% to 15% of cases. However, the quality of the second opinion is crucial, as it can either improve or hinder the diagnostic process. Studies on independent second checks for specific tasks have found mixed effectiveness. The value of patient-initiated second opinions in general medical practice remains uncertain and requires further investigation.
Evaluation of Outcomes From a National Patient-initiated Second Opinion Program
Meyer et al. found that patient-initiated second opinions resulted in changes to diagnosis and treatment recommendations for a significant number of participants. Around 15% of patients had their diagnosis changed, 37% had their treatment changed, and over 10% had both changed.
Virtual Second Opinions
In the post-pandemic era, virtual second opinions have gained popularity as a preferred option for patients seeking additional medical advice. Virtual second opinions provide convenience and accessibility, allowing patients to receive expert advice from the comfort of their own homes.
Furthermore, virtual consultations offer a faster turnaround time, as patients can connect with specialists more efficiently and avoid scheduling conflicts. Additionally, virtual second opinions often involve collaboration among multiple experts, enabling patients to benefit from a diverse range of medical perspectives. This can enhance the accuracy of diagnoses and increase the likelihood of appropriate treatment recommendations. Overall, virtual second opinions have the potential to improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs.
Virtual second opinion vs. in-person second opinion
While telehealth is increasingly supporting virtual second opinions, there are certain scenarios where an in-person second opinion is advised. In-person consultations may be necessary when the physical examination is crucial for accurate diagnosis or when specific medical procedures or tests need to be performed.
Some situations that may require an in-person second opinion include complex surgical cases where a thorough evaluation of the patient's condition and physical examination are vital, cases involving intricate diagnostic imaging or pathology analysis that require specialized equipment, and instances where the patient's medical history and records need to be reviewed extensively.
In-person second opinions can also be beneficial when a patient prefers face-to-face interaction with the specialist or when there are unique circumstances that necessitate an in-person evaluation.
The Benefits of Seeking a Second Opinion
Let us take a look at the benefits of seeking a second opinion:
- A second opinion gives a fair insight into the available treatment options and makes the patient feel empowered and in control.
- Second opinions help in confirming if the diagnosis is appropriate. It helps the patient ask all the right questions related to the diagnosis, ensuring that the patient receives an optimal treatment plan.
- Getting a second opinion from a physician in a health system that makes use of cutting-edge equipment and technology may open up more possibilities for treatment.
To sum up, the value and impact of patient-initiated second opinions in general medical practice are still largely unknown. This review sought to examine the traits and reasons why patients seek second opinions, as well as the clinical results and associated patient satisfaction. Based on studies that provided data on clinical agreement and patient perspectives, it was found that while second opinions often confirm the original diagnosis or treatment, a significant proportion of cases (10% to 62%) result in major changes in diagnosis, treatment, or prognosis.
Patients seek second opinions for various reasons, largely perceiving them as valuable. However, the literature on patient-initiated second opinions remains limited, and the accuracy of these opinions over time requires further research. There is a need for standardized methods and outcome measures to determine the true value of second opinions, with a particular focus on their potential to reduce diagnostic errors.
- Weyerstraß, J., Prediger, B., Neugebauer, E., & Pieper, D. (2020). Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion. BMC health services research, 20(1), 1-9
- Payne, V. L., Singh, H., Meyer, A. N., Levy, L., Harrison, D., & Graber, M. L. (2014, May). Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. In Mayo Clinic Proceedings (Vol. 89, No. 5, pp. 687-696). Elsevier.
- Meyer, A. N., Singh, H., & Graber, M. L. (2015). Evaluation of outcomes from a national patient-initiated second-opinion program. The American journal of medicine, 128(10), 1138-e25.
- Payne, V. L., Singh, H., Meyer, A. N., Levy, L., Harrison, D., & Graber, M. L. (2014). Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clinic proceedings, 89(5), 687–696.
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