Most patients believe and trust a diagnosis and treatment plan their physician provides them. So why is a second opinion in medicine so important? The “practice of medicine” is a term used to imply a variety of diagnoses and treatments. Yes, there is a standard of care in every medical discipline, but there are also many physician-driven distinctions in getting to a definitive diagnosis with a treatment plan. These decisions have many caveats and directly impact a patient’s care and outcome. In 1972, second surgical opinion programs were established to improve medical care and control health care costs. Today approximately one in 20 patients are exposed to preventable harm in medical care. We coin this harm as a medical error.
A medical error is an unintended act of omission or commission or does not achieve its intended outcome. It is further defined as the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning) or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual (physician/surgeon) or system (hospital) level.
The list of medical errors is constantly expanding to categorize preventable factors and events better. Nonetheless, statistically speaking, if a medical error were considered a disease, it would rank the third leading cause of death in the U.S.
Why should you get a second opinion?
Second opinion consultations can significantly change diagnosis, treatment, or prognosis in a substantial proportion (10%-62%) of cases.
In 2017 a study by Mayo Clinic found that second opinions usually resulted in a change or refined diagnosis. Of the 286 cases reviewed, only 12% of patients had the same diagnosis after their first and second opinions. However, in two-thirds of the cases, the second opinion revealed more information that was viewed as essential and resulted in a refined diagnosis. It has been well documented that overconfidence by a physician or surgeon can lead to diagnostic error. Implicit and unconscious biases are also well-known factors that can lead to differential medical treatment and possible errors. Interestingly the final diagnosis in the remaining 20% was distinctly different from the initial diagnosis.
Patient safety strategies are now more in vogue; thus, the need for second opinions is increasing. The advancement of technology and instant access to information (Google, WebMD and so many other online health information sites) leads to a patient-driven demand for better health care and treatment options. This expansion in health information via technology and social media is a two-edged sword with lots of disinformation; thus, patients should beware.
In the end, the patient-physician relationship is crucial to overall decision-making for any plan of care, treatment, or surgery. There are many variations in the reviewed studies in health care literature as to the cost-effectiveness of second opinions in medicine. These studies could be easily misconstrued that there are no benefits to second opinions, thus possibly leading to little pay or no pay by insurance companies. A patient should consider the substantial short and long-term implications of their body’s health and well-being. In other words … it is worth it. Go with your intuition. When in doubt, or if you have more questions, get a second opinion.
It will benefit the patient’s treatment course and outcome.
Guidelines to consider when to get a second opinion:
- When given a serious medical diagnosis
- A long time with an illness
- Surgical decisions
- A new or unusual treatment plan
- Not pleased with an initial diagnosis
- Poor relationship or communication with physician/surgeon
- Not given a reasonable time for decision-making and planning
Guidelines of how to obtain a second opinion:
- Referral by the current physician/surgeon (they should not be insulted but accepting of your decision)
- Make your appointment or call your insurance company and get a recommendation (most will pay)
- Referral by a friend or family member
- Telemedicine (online platforms that your insurance may cover or out-of-pocket cost).
To err is human. “The health care system is designed by humans, and error is inevitable as long as humans are involved. Personality, gender, motivation, and other constitutional factors will give rise to variation, which in turn begets uncertainty and unpredictability and, inevitably, error.”
So, think again! Consider a second opinion for your own peace of mind, and more importantly your medical safety.
Sonya M. Sloan is an orthopedic surgeon and author of The Rules of Medicine: A Medical Professional’s Guide for Success.