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The evolution of the medical second opinion

Abbie Leibowitz, MD
Physician
January 31, 2016
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Requesting a second opinion can be a touchy subject for a patient. I’d like to think that when I was in practice, I was never offended when a patient’s family requested a second opinion, but that probably doesn’t universally reflect my response in every circumstance. But I am confident in saying that as often as not, I would be the one suggesting that we get another pair of eyes to look at the problem. As physicians, second opinions often help us learn from each other and expand our knowledge of new treatment options. And second opinions can help patients make better informed decisions about the care they receive.

A 2013 Harris Interactive poll found that only 19 percent of those surveyed said they sought a second opinion for a medical condition. That actually sounds about right to me overall, but it would seem low if one focuses on serious and complex conditions. In most settings, I think that it would be unusual for physicians not to encourage patients with serious or life-threatening conditions to get another opinion from an expert. So why doesn’t this happen? It is likely due to a number of reasons. From the patient’s perspective, there can be fear of offending the treating physician, blind acceptance of the initial diagnosis or treatment plan, feeling that a second opinion will delay treatment, or a lack of available alternatives in the local community.

The first few concerns can be addressed through education and open discussion, but is there something we can do about geographical limitations? Technology has expanded the reach of our networks and access to resources, enabling physicians to connect with colleagues nationwide and around the world, and now, so too can patients.
As medicine continues to evolve, so does access to second opinions. Emerging partnerships between health systems, ranging from community hospitals to major academic research centers, enable patients in even the most remote areas to get second opinions from specialists around the country.

Leading health systems like the Cleveland Clinic, Johns Hopkins University Medical Center and others make top doctors available to patients nationwide. Insurers and employers also see the benefit of providing coverage for remote chart based or online second opinion services to patients. The result can be not only improved patient outcomes but frequently, reduced costs. Providing the right care is not only the best thing to do to assure the most successful medical outcome, it is cost effective as well.

For the patient unable to travel or with limited access to local experts, remote consultations that take advantage of video chat and electronic image sharing can make all the difference in the care one receives. FaceTime and Skype are not just for talking to the grandchildren any more! And in most cases, patients don’t have to leave their community to take advantage of these expert opinions. Many specialists in academic medical centers have become accustomed to collaborating across great distances, effectively co-managing patients with their local physicians and bringing the resources of the university center to the patient, wherever they live.

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.

Second opinions are a valuable tool to ensure patients are engaged in their health care. By helping patients understand and utilize all available options to get a second opinion, whether from near or far, we can help them make the best decisions for their health.

Abbie Leibowitz is co-president and chief medical officer, Health Advocate.

Image credit: Shutterstock.com

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