Why Second Opinions Count


Actress Rita Wilson, who recently announced her breast cancer diagnosis and subsequent double mastectomy, did the right thing when she sought out a second opinion. And doing so might have saved her life.

But too many of us are hesitant to question a medical diagnosis: a 2005 Gallup Poll that surveyed 5,000 Americans found that about half reported “never” seeking a second opinion and a paltry 3 percent always sought out a second opinion on a diagnosis, treatment, drug or operation.

Even after four years of college, four of medical school, and three to seven more of residency, doctors still may not get diagnoses right on the first try.

In fact, they’re more likely than not to be at least a little off. In a study published (paywall) April 4, researchers from the Mayo Clinic in Rochester, Minnesota found that 88% of the time, a patient’s original diagnosis changed at least slightly when a second medical professional was consulted.

Misdiagnosing a patient can sometimes be fatal, but how often is unclear. Last year, a controversial study from Johns Hopkins University said that medical error which includes mistakes in diagnosis are the third-leading cause of death in hospitals behind cancer and cardiovascular diseases in the US.

As ProPublica notes, doctors don’t list medical errors on death certificates, so counting the actual number of deaths presents its own set of challenges. That said, the National Academies of Medicine estimates (pdf) that diagnostic errors lead to up to 10% of all patient deaths, and up to 17% of all hospital complications.

For the Mayo Clinic study, physicians gathered the medical records of 286 patients who visited a primary healthcare provider between 2009 and 2010. Each patient was either prompted to seek a second opinion, or found one on their own every single one did get a second opinion, though.

Only 12% of the patients came out of visits to a second physician with the same diagnosis; 66% of patients had a slightly altered diagnosis, and about a fifth were told they were suffering from a completely different condition.

The fact that these patients sought any kind of second opinion means their cases were probably not straightforward. But even if they were, diagnosing is never easy. “There are 10,000 diseases and only 200 to 300 symptoms,” Mark Graber, a physician and founder of the Society to Improve Diagnosis in Medicine, told the Washington Post.

There’s an innumerable amount of combinations of symptoms that a patient could bring to a doctor, which could indicate one of those 10,000 diseases, or a number of them. The more symptoms you add, the more complicated it becomes to match them to different diseases. And there’s no limit to just how many illnesses from which a patient can suffer.

If anything, the Mayo Clinic’s results suggest that medicine should be a collaborative process. Doctors and other health care providers have to rely on each other to bounce ideas off to make sure patients get the right diagnoses so they can get proper treatment faster.

And physicians need to include patients in those conversations, too. “Most of the stuff you learn in medical school is kind of useful background noise, but it doesn’t tell you anything about the patient in the bed,” Lisa Sanders, a physician and author of the “Think Like a Doctor” told Quartz. “[Medicine] is teamwork.”

Pretty frightening statistics, don’t you think?

Years ago, when my own breast cancer diagnosis was still fresh, a woman I didn’t know very intimately opened up to me during a play date for our sons. “I have a lump in my breast,” she said, offhandedly. “Did you have a mammogram?” I asked. “Yes, and it was negative. So my doctor told me not to worry.”

I must admit that I got a little no, a lot pushy (in retrospect, it was a good thing, but the fiery passion I felt was out of character for me). “Are you kidding? Don’t take your doctor’s word for it! Go get a second opinion!”

She did. And it was cancer. Today, many years later, she’s cancer-free. When we occasionally run into one another, we hug warmly, and she thanks me for that day. According to studies, 30 percent of patients who sought second opinions for elective surgery and 18 percent of patients who whose insurance company required them to seek a second opinion found that the two opinions were not in agreement.

Here’s another example of why second opinions are so important: a 2006 study found that when breast cancer patients came to a specialty center for a second opinion, recommendations for surgery changed for more than half, a result of different interpretations and readings of mammograms and biopsy results.

Get an Expert Opinion Without Leaving Home

Our online second opinion program offers patients access to leading specialists at UCSF Medical Center, no matter where they live. If you are facing a complex medical issue or difficult treatment decision, having a second opinion from a world-class academic medical center can provide valuable guidance and peace of mind.

UCSF has partnered with Grand Rounds to deliver this service. Because Grand Rounds takes care of gathering medical records and coordinating the review, the process is simple, convenient and completely confidential. Since everything is done remotely, there is no need to travel to San Francisco.

The fee for the service is $700. Please be aware that most insurance plans currently do not cover the cost of online second opinions.

Our remote second opinion tool can be very helpful if:

  • You want a second opinion on your diagnosis
  • You want a second opinion on recommendations for surgery or a complex treatment plan.

Why would anyone shy away from second opinions?

  • They may feel that time is of the essence.

A cancer diagnosis is scary; and waiting on it is scarier still. Many people feel that they have to act immediately and get treatment right away; taking time to check out options, waiting for another medical appointment and sitting with the worry might just prove too difficult. While in some cases, it’s imperative to take immediate action, most people can and should take some time to learn about the disease and weigh their options. Only then can they make an informed and educated decision.

  • They may fear that they’ll insult their physician.

How can I doubt what she’s telling me? What will he think of me if I go to another doctor? But the truth is that most doctors will welcome second opinions from another professional. They (should) understand your desire to be well-informed and an advocate for your own health. Many times they will recommend a specialist for you to see.

  • They may feel like medicine is an exact science.

Medicine has made tremendous advances, but many times, it’s interpretive and not definitive. Not every doctor comes up with the same diagnosis. Not everyone agrees on treatment choices. And not every radiologist interprets imaging tests the same way.

Keep in mind that there are so many factors that can influence opinions and diagnoses, such as technology, where the physician was trained, the level of experience in dealing with your particular diagnosis and his or her philosophy about treating something aggressively or taking a more wait-and-see approach.

  • They may fear they will be even more confused.

What if the two opinions don’t match up? Then what? Sometimes that indicates you need to seek a third opinion, and then go with the one that gets the most votes.

  • They may not want to incur the added expense.

Most insurance plans will pay for at least part of the cost (and Medicare will pay 80 percent of the cost), assuming the testing is medically necessary, according to The Patient Advocate Foundation, which recommends calling your insurance provider in advance to avoid any problems or questions about billing.

Arrive at your appointment prepared with all your previous medical records (you do have the right to all copies!), contact information about the first physician and, as always, your insurance card, list of prescribed medications and allergies, and any diagnostic test results.

For more information visit us our website: https://www.healthinfi.com

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