Most individuals, at the very least, face one major health-related decision at one point in their lives. Sometimes their diagnosis or treatment plan may not be clear and when it isn’t, a patient may be interested in getting a second opinion. As a doctor, what is your responsibility in this situation? If a patient decides to seek care elsewhere, what you need to remember is that it is their choice. It is not about you. “If your physician doesn’t support you getting a second opinion, see how fast you can run. Any doctor who is any good at what they do will welcome a second opinion, because it will usually be a confirming opinion” said Trisha Torrey, patient advocate. No patient should have to deal with the stress of staying with a doctor just out of fear of upsetting them or out of politeness of keeping them happy. If you know that a certain doctor in a certain town, city or state is a patient’s best bet for a second opinion, it is up to you to refer them and encourage them to seek their care.
According to data gathered from PinnacleCare, out of 1,000 medical cases where patients received a second opinion, over 77% of the cases led to changes in diagnosis, treatment and/or physician. Research found that 3% of patients ended up with a change in diagnosis, 21% of patients ended up with a change in treatment, and 41% ended up with a change in physician. 18 individuals who were going to receive surgery ended up not needing it after all. “That's a remarkable statistic. It's pretty eye-opening, even to those of us in this business who do this every day. Medicine is an art as much as a science. Even well-meaning, bright physicians can disagree” said Miles Varn, chief medical officer at PinnacleCare. According to Varn, the more information patients receive relating to their health, the better outcomes they will likely end up with. “Technologies and thought leader-based approaches may not be available in community settings that are available elsewhere. Without a second opinion at a center of excellence, the patient might not understand that there are unique opportunities for either a clinical trial or care, but it could be an opportunity for them to take advantage of and possibly lead to a better outcome” he said.
Asking for a second opinion may be a sensitive subject for a patient. Perhaps this may be out of fear that they will offend you, out of fear that a second opinion will only delay their treatment, or they may not want to accept their initial diagnosis. Such concerns can be addressed through open communication and education and whatever the case, it is up to you to encourage him or her to get second opinion if they require it. “One, you need all the medical records and any pathology slides or other test results to give to whoever is giving the second opinion. Two, you want the experts to discuss in an open way what the areas of agreement and disagreement are. If you don't tell your doctor because you're afraid you're going to insult him, it's hard to get the records together and communicate” said Dr. Jerome Groopman, professor of medicine at Harvard medical school and author of the book Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine.
As healthcare continues to advance, so does patients’ access to more options, such as a second or third opinion. In today's day and age, technology has progressed to a point where partnerships have arisen between healthcare systems such as hospitals and research centers, physicians and patients can interact with one another through social channels and networks, and patients can receive second opinions even in remote areas from experts around the globe. Leading medical centers are making ‘the best doctor in my city’ available to patients on a national level and insurers/employers are seeing the benefit of providing insurance coverage / online services to patients. This, in turn, can not only help improve patient outcomes, but also help reduce healthcare expenses.
Should you convince patients to travel for a second opinion? The answer is yes. Even if a patient is reluctant, perhaps out of fear that it will delay their treatment, you should inform them why it is in their best interest to seek care from that particular top doctor at that particular town, city or state. If a patient is not permitted or unable to travel for whatever reason, remote consultations can help so make use of video chats and image sharing. In fact, nowadays, several experts have adapted technology to collaborate with one another from across far away distances, helping manage patients’ care along with their local doctors. If a patient is hesitant of seeking care elsewhere due to medical expenses, you need to inform him or her of the medical costs relating to their unique situation and whether their second opinion care plan is covered by insurance. “This is one of the major flash points for a patients' bill of rights and the whole issue of managed care. Each plan differs as to the level of choice and freedom you might have to see someone inside and outside the network. If you're restricted, or in a situation where the diagnosis is not clear, or you feel the best treatment exists at another institution, then you need to advocate for yourself quite loudly” said Dr. Groopman.
Sometimes, you may recognize that your field of expertise makes you an unsuitable fit to treat a patient’s particular condition. You should inform them about what you are comfortable with doing and let them know that they have other options. While it is only natural to fear losing business or valuable time invested in a patient’s condition, misdiagnosis or medical errors can result in greater losses. They can take a toll on your reputation as well as the reputation of your practice. If anything, referral to another doctor can prove you are, medically, on the right path or simply reassure /comfort your patient, through a different approach or explanation, that the right thing is being done for them. “I worry about what the outcome might be for aggressive treatment. I worry about patients being exposed to toxicities I don't think they need. I spend time reflecting on my interactions with them. Did they really get me at my best? We all have good days and bad days—days where it's crazy and distracted, with lots going on. Sometimes it's just that I'm not the best person for a patient. My approach isn't the best for them. The best solution for them is to see someone else” said Kathy Miller, oncologist and associate professor of medicine.
“Second opinions are not always different than the first, or better, and sometimes the right facility for that patient is the one in their backyard. But by using evolving technology to access a second opinion not otherwise available, patients can feel more confident and in control of their decisions, which can have a big impact on outcomes. And because we’re no longer limited to the local area or required to travel to meet with far away specialists, patients can obtain trusted second opinions quickly and efficiently, helping them feel more secure in their care and helping us ensure they get the best treatment when they need it” wrote Dr. Abbie Leibowitz, founder and chief medical officer of Health Advocate, Inc. As a healthcare professional, second opinions offer you the opportunity to collaborate with and learn from other professionals within your field on the latest medical news, trends, procedures, and treatment options. Second opinions also allow your patients to become engaged in their own care, whether near or far, and make better-informed decisions about their health.