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The value of getting a second opinion

By 2023, public health's share of total health

By 2023, public health's share of total health expenditures is projected to fall to 2.4 percent, the researchers estimate. Photo Credit: iStock

Actress Rita Wilson, who was diagnosed with breast cancer and underwent a double mastectomy recently, told People magazine in April that she expects to make a full recovery "because I caught this early, have excellent doctors and because I got a second opinion." When confronted with the diagnosis of a serious illness or confusing treatment options, it can be useful to seek out an extra perspective. Knowing that a second physician agrees with the first one can provide clarity and peace of mind. And a second set of eyes may identify information that was missed or misinterpreted the first time.

A study that reviewed published research found that 10 to 62 percent of second opinions resulted in major changes to diagnoses or recommended treatments.



Another study, which examined nearly 6,800 second opinions provided by Best Doctors, a second-opinion service that some companies offer their workers, found that more than 40 percent of second opinions resulted in diagnostic or treatment changes.

But while there is no dispute that an individual patient's treatment or outlook can be improved by getting a second opinion, there's little hard data showing that second opinions lead to better health results in the population overall.

"What we don't know is the outcomes," says Hardeep Singh, a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, who co-authored both of the studies mentioned above. "What is the real diagnosis at the end? The first one or the second one? Or maybe both are wrong." That doesn't mean second opinions are a bad idea. Experts estimate that diagnostic errors occur in 10 to 15 percent of cases.

"There's no getting away from it: Diagnosis is an imprecise thing," says Mark Graber, a senior fellow at the research institute RTI International and one of Singh's co-authors.

Second-opinion requests were related to diagnoses in 34.8 percent of cases in the Best Doctors study. These included 22.5 percent of patients whose symptoms hadn't improved, 6.3 percent who hadn't received a diagnosis and 6 percent who had questions about their diagnosis.



Treatment options can also be confounding. The Best Doctors study found that more than half of second-opinion requests were related to treatment questions. In 41.3 percent of cases, people were trying to decide among different treatment options, while 18 percent were trying to decide whether to proceed with surgery.

Getting a second opinion may not involve a face-to-face meeting with a new specialist, but it will certainly involve a close examination of the patient's medical record, including clinical notes, imaging, pathology and lab test results, and any procedures that have been performed. Some people choose to have that second look done by physicians in their community, but other patients look for help elsewhere.

Some medical systems, including the Cleveland Clinic and Johns Hopkins in Baltimore, offer patients online second opinions. "It really does give people relatively easy access to expertise," says C. Martin Harris, chief information officer at the Cleveland Clinic.



The Cleveland Clinic's MyConsult service doesn't accept insurance. A second opinion costs $565; if it includes a pathology review, the cost rises to $745.

Face-to-face meetings with specialists who are asked to provide a second opinion and review a patient's medical record are more likely to be covered by insurance than an online consult, but nothing is guaranteed.

Of course, asking for a second opinion doesn't necessarily mean accepting the advice. In the Best Doctors survey, 94.7 percent of patients said they were satisfied with their experience. But only 61.2 percent said they either agreed or strongly agreed that they would follow the recommendations that they received in the second opinion.


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