Second Opinions Often Lead to Recommended Changes

Marcia Frellick

May 29, 2015

Second opinions led to recommended changes in diagnosis or treatment for more than 40% of participants in a program that offers them free of charge to employees and their beneficiaries. The effect of second opinions on clinical outcomes remains unclear, however.

The second opinions, which have been suggested as a strategy to prevent diagnostic and treatment errors, were estimated to have a moderate or major clinical effect on diagnosis in 20.9% of cases, and on treatment in 30.7% of cases.

Results from this study, performed by Ashley Meyer, PhD, from the Michael E. DeBakey Veterans Affairs Medical Center, Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, and colleagues, were published online April 23 in the American Journal of Medicine.

The independent research team gathered data from opinions completed between January 1, 2011, and December 31, 2012. They then aggregated and analyzed the data to determine outcomes of the program.

Requests Highest for Orthopedic Surgery

Physicians from the nationally administered program Best Doctors Inc completed 6791 second opinions across medical specialties. Almost half of the requests fell within five of the 34 represented specialties. Requests were heaviest in orthopedic surgery (1195), followed by medical oncology and hematology (588). Requests in family medicine (four requests) and in sleep medicine (five requests) were the least common.

The main reasons for requesting second opinions were for help choosing treatment options (41.3%) and for diagnostic concerns (34.8%).

Most of the second opinions confirmed (56.8% and 26.4% for diagnostic and treatment opinions, respectively) or clarified (17.0% and 26.9%) the original opinion for both diagnosis and treatment-related issues.

Second opinions resulted in changes in diagnosis 14.8% of the time and changes in treatment 37.4% of the time. The second opinions resulted in changes in either diagnosis or treatment 41.5% of the time, and changes in both 10.6% of the time.

Among the 2683 patients surveyed, most (94.7%) were satisfied with the second-opinion experience, but only 61.2% planned to follow the recommendations.

The authors note that further evaluations, including long-term follow-up of outcomes, would be needed to determine whether the second opinions were correct and whether they reduced the risk for diagnostic error. Further studies could also determine why patients choose one opinion over the other.

The findings may have implications for future use of second opinions: "First, there is a growing appreciation of diagnostic error," the authors write. "Recent estimates in US ambulatory care settings suggest that one in twenty patients will experience a diagnostic error annually. Second, patients are increasingly becoming interested in becoming active partners in their care."

This work is supported in part by the Department of Veterans Affairs and the Center for Innovations in Quality, Effectiveness and Safety. A coauthor is supported by RTI International. The other authors have disclosed no relevant financial relationships.

Am J Med. Published online April 23, 2015. Abstract

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