What patients should know before seeking second opinions

While many physicians agree that it's helpful for patients to seek a second medical opinion about a serious diagnosis or treatment plan--especially considering diagnostic errors occur in 10 to 15 percent of cases--the common practice is not always simple. A recent post from Kaiser Health News highlighted several caveats regarding second opinions, which may be useful for physicians and patients to understand and discuss.

For starters, there is little hard evidence to prove that second opinions improve outcomes, according to Hardeep Singh, M.D., a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston. "What is the real diagnosis at the end? The first one or the second one? Or maybe both are wrong" she said.

One reader comment on a recent FierceHealthcare article that supported the idea of second opinions based on research showing that 77 percent of second opinions led to a change in diagnosis, treatment plan or physician made a similar point: "OK, I agree [diagnoses] are often wrong, [but] getting a true second opinion is nearly impossible. So we are saying the statistics here show a lot of changes in treatment plans, etc. But how did the patients fare in achieving their health goals? Changes don't always mean better."

Another potential problem surrounds patients' out-of-pocket costs. Several online services that offer patients access to additional medical expertise come at an expense. The Cleveland Clinic's MyConsult service, for example, doesn't accept insurance. A medical second opinion costs $565, according to KHN, while a consultation with a pathology review costs $745.

And even for face-to-face visits, coverage is not guaranteed, especially if a patient decides to seek a specialist outside of his or her insurer's network, KHN noted. What's more, many insurers won't pay for diagnostic or other tests to be redone, regardless of the physician who recommends it, said Erin Singleton, chief of mission delivery at the Patient Advocate Foundation.

But while physicians may advise patients to approach second opinions with caution, it's essential they partner with patients in their quest to find the best available answers. Responding defensively or unfavorably to a patient's desire to get another opinion, on the other hand, can harm the physician-patient relationship, FiercePracticeManagement reported previously.

To learn more:
- read the article