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What is a second opinion?

Second opinions are simply an independent review by a doctor or an expert in the same field of a medical diagnosis or a treatment recommended by another doctor.


Second opinion
Second opinion

When do you need a doctor's second opinion?

There are multiple reasons to get a doctor's second opinion.


  • To get clarity on a diagnosis: Patients seek a better understanding when the initial diagnosis seems vague or complicated. This can be in the form of additional information or analysis of medical history and reports and a review of the currently recommended course of action.

 

  • To decide on the appropriate course of treatment: Patients need more information on the pros and cons of a complicated treatment’s costs, risks and its benefits. In this situation, patients seek expert opinions from specialists for possible “new” information, clear guidelines regarding the treatment sequence, and clearing confusion in the management of the illness, the treatment, and post-treatment care.  

  • The review could also result in additional therapeutic modalities that will dramatically enhance the patient’s current care or correct a flawed treatment plan. You will be surprised to know that discrepancies between two medical experts have been reported to be over 25%.  Also, for example, in clinical assessments of breast cancer, differences have been reported in over 20% of the cases.

  • To validate/confirm diagnosis and treatment: If a diagnosis has been made and its treatment regimen explained by the initial physician, the patient may seek another opinion from a domain expert to confirm the process as it may involve a drawn-out and expensive treatment protocol. The adage “Two heads are better than one” is applicable here.  

  • When the diagnosis is that the condition is either rare or seems like an untreatable medical condition: In some situations, where the diagnosis on offer is very complicated and outcomes expected to be poor, patients seek more information from experts for decision making.

  • Physician-initiated expert request: There are situations when the treating physician understands the complicated nature of the ailment and advises the patient to consult another expert before making a decision. This gives the patient additional insight and validation of the recommendation at hand but also potentially other options.   

This is common among rural doctors or secondary care physicians who may not have cutting-edge knowledge about an illness and therefore do not want to jeopardize the outcome because of their possible gaps in knowledge.

 

This also applies when the physician perceives a patient’s dissatisfaction with his diagnosis and therapy.


How effective are expert second opinions?

There is no hard data on this. However, with increasing access to medical information and awareness of patient rights, more and more patients are seeking additional advice. And in the case of serious medical issues or complex treatments, there is increased interest in getting an expert second opinion. In terms of the outcome of getting a second opinion, the trend seems to be a greater benefit to the patient.


  • In one large national sample, one-fifth of patients who saw a doctor in the past year sought a second opinion, and this fraction exceeds 50% in patients diagnosed with cancer.  

  • In a survey conducted in Japan, most patients who obtained another opinion reported they better understood their treatment options (93%), their illness (88%) and the risks of their treatment (82%).  

  • In one study of cancer patients published in the Journal of Cancer Research and Clinical Oncology, 7% to 36% sought second opinions and changes to diagnosis, treatments, outcomes occurred in 12% to 69% of the cases.  

  • In a review published in the British Medical Journal, discrepancies in the diagnosis were present in nearly 58% of the cases.   

  • A Mayo Clinic study reported that among the patients that came to the clinic for a second opinion, nearly 88 percent had their diagnosis and care plans altered.


Why are patients reluctant to get a second opinion?

Traditionally patients hesitate to get a second opinion due to fear of offending their current physician. However, with increased access to medical information online, providers are aware that any diagnosis, procedure, or medication is reviewed against information from popular medical content websites. So physicians expect that patients lean towards second opinions in a number of situations. Many physicians themselves advice patients to get another opinion on the current course of action.


What are the situations where a second opinion may be required?

Second opinions have traditionally conjured up an image of a life-threatening condition. However, they are applicable in a broader set of situations. Lifestyle altering conditions such as knee replacements, major aesthetic procedures,  experimental procedures and drugs, or even simply expensive procedures or treatments where there may be lower cost alternatives are all situations where a second opinion may be beneficial.


Summary

Patients may find comfort in the fact that they are empowered to make informed decisions: either re-affirmation of their medical condition or hopefully newer or better diagnostic or treatment options offered by the second expert.  From a medical economics point of view, second opinions may lower healthcare costs, reducing both over-and under-treatment.

 

So, the next time you are confronted with a situation where you find it difficult to make a decision on the course of diagnosis or treatment, do not hesitate to seek another opinion from a domain expert either in person or online.  You could  benefit immensely from the information, insights, and /or advice   you receive. 



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