"Best Doctors" Offer Second Opinions

Colin T. Son


May 26, 2009

Second opinions are an accepted if not routine part of medical care and are based on the notion that 2 heads are better than one. Capitalizing on that theme, Best Doctors is a corporate service that provides expert reviews of medical diagnoses and treatment plans. A growing number of employers are offering the service as a health benefit to their workers, hoping to improve the quality of care and to potentially save money by avoiding unnecessary or inappropriate treatments.

Evan Falchuk is the president and chief operating officer of the Boston-based consultation service, founded in 1989 by physicians affiliated with Harvard Medical School. As part of the company's goal of improving the quality of healthcare, he also maintains a blog, See First, where he writes about patient cases, the doctor-patient relationship, and other related issues. The name of the blog comes from a quote by Sir William Osler, considered the "father of modern medicine":

Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first.

Colin Son: Is there really a need for services like Best Doctors?

Evan Falchuk: Studies show that patients get the wrong diagnosis as much as 20% of the time and the wrong treatment half of the time. Many of these problems happen because doctors aren't able to spend as much time with their patients as they once could. Lots of studies show the impact that this "time gap" has on decision-making. We spend the time it takes to review a patient's information, figure out what the problem is, and consult with an expert to help the doctor solve it correctly.

See First hosts Grand Rounds
May 26, 2009

Colin Son: Is there a certain profile of the "best doctors" who review the cases that are brought to you?

Evan Falchuk: There are 2 stages of review at Best Doctors. First, we have internists on each case who figure out what is going on and what the right questions are to ask. They are all practicing doctors -- people who are dealing with patient care on a daily basis. Picking these doctors is an extensive process; we want doctors who are very, very good at identifying problems to present to the experts.

The experts are drawn from our Best Doctors database, which contains about 40,000 doctors. The only way to get in the database is to be voted in by your peers. We have been systematically conducting surveys for this for the last 2 decades. I like to think of the result as a sort of "reputational map" of the medical profession -- a sense of who the doctors are that other doctors respect the most. It is a powerful tool to match the specific need in a case with specific expertise. It also gives us confidence that the response we get will be coming from a highly respected source.

Colin Son: What's the incentive for employers to pay for your service? Is there a cost savings associated with it?

Evan Falchuk: Yes, there are cost savings, and this is one reason why employers buy Best Doctors. It's pretty easy to see how avoiding an incorrect diagnosis or treatment saves money. We have clients report to us very significant savings from this. There is also a big impact on productivity by helping people with these problems.

But I must say that one of the biggest motivations I see from employers is a desire to do right by their employees. There is a lot of frustration among employers with our healthcare system and a desire among employers to give employees something that truly helps them navigate it.

Colin Son: What is your relationship like with the broader medical community? Do you ever get push-back from private physicians when reviewing their patient's case?

Evan Falchuk: We work very well with doctors and we have an enormous amount of respect and admiration for them. Making medical decisions is hard, especially in a highly fragmented system like ours. We help the patient and their doctor put together all the pieces of the patient's case so that the right decisions can be made. Doctors appreciate that level of information, but only if it's useful, pertinent, and respectfully presented. We work very hard at all of those things.

Doctors are people too, so of course we see the full range of human reactions to getting presented with new information. But in general, I am impressed by the extent to which doctors are interested in what we provide and the support that we get from the medical community. We have been doing this for 20 years, so we must be doing something right.

Colin Son: Why did you decide to start a corporate blog?

Evan Falchuk: The public discussion in our country is too fixated on the question of how we pay for care and is not focused enough on making sure that it's being done right. We have something very important to say about this, and the blogosphere is where this is happening. We had to be part of that conversation.

The blog has given me the opportunity to connect with doctors, patients, employers, policy-makers, and others who really care about these issues. I feel like our voice in this discussion is grounded and realistic and not theoretical. I've been fascinated by the extent to which I get feedback from readers who tell me that they have had similar experiences with what it's like to be sick. It is very motivating.

I think every company needs to have an active blog presence. My goal is to have a regular conversation with our customers, doctors, prospects, whoever, so that I can learn as much as possible about what we need to be doing to serve them better. As much as our whole business is based on the idea that it's easy to miss something, we need the collective wisdom of our customers to help us make sure that we're never missing anything.

Colin Son: What is the future of Best Doctors and other second-opinion services?

Evan Falchuk: The demand for what we do is very high. We now cover millions of people, and I expect this kind of growth to continue, especially as consumers become more and more engaged in medical decisions. So we have a lot of work ahead of us.

The healthcare market is changing too, regardless of what happens with healthcare reform. More than ever, consumers and doctors want to make decisions without restrictions from insurance companies or the government. This is a fundamental challenge to the existing system and it is an accelerating trend. Companies that are in the business of helping patients and doctors do this are going to benefit the most. I think we are well positioned for that.

This week, See First is hosting Grand Rounds, a collection of posts from across the medical blogosphere. Visitors can sample blogs written by physicians, nurses, patients, and others involved in healthcare while getting to know the host blog.