Doctors' Love/Hate Relationship With Second Opinions

Neil Chesanow

Disclosures

June 18, 2015

In This Article

"Second Opinions Are Overrated"

War, as the saying goes, is too important to be left to the generals. Is this true when choosing a doctor for a second opinion as well? If a patient is diagnosed with cancer or another serious condition or is thought to need major surgery, is sending the patient to another doctor in the practice, or a doctor who happens to be listed in the provider directory of the patient's insurer, sufficient due diligence?

Frank J. Veith, MD, professor of surgery at Case Western Reserve University in Cleveland, Ohio, and at New York University in New York, and chair of vascular surgery at the Cleveland Clinic, doesn't think it is. Dr Veith takes a contrarian view of second opinions. He thinks they are "overrated."

In an email to Medscape, Dr Veith laid out his argument:

"A middle aged man goes to his primary care physician for his annual check-up. Because of an abnormal physical finding or laboratory test, he is referred to a specialist, who, after additional tests, recommends an operation with considerable risks. Before agreeing to the procedure, the man decides to seek a second opinion. This sequence of events occurs routinely, as the second opinion is generally accepted as one of the sacred cows of American medical care.

"Let's examine this sacred cow to see if it is a good thing or an overrated practice, which serves little useful purpose. First, the potential advantages. If the second specialist agrees with the first opinion, it can be reassuring to the patient and his family, but it really is unnecessary. On the other hand, if the original specialist is less than optimal or motivated by the financial rewards of performing his recommended procedure, the second opinion can possibly benefit the patient by saving him from an unnecessary, wrong, or possibly harmful operation. However, why not solicit the opinion of the second, better specialist first?

"Now the downside. If the second specialist disagrees with the first, the patient faces a dilemma. He has to pick between the two specialists. How does he do this? Does he follow the advice of the more articulate and likeable specialist? Does he pick the opinion he likes, despite being a nonexpert? Does he solicit a third opinion—a tie breaker? Taking a vote on a medical or scientific question does not assure arriving at the correct answer—especially if the vote is 2:1, and especially if one of the specialists is self-appointed or a full-fledged phony. So disagreement between the first and second specialist does not assure better care. It can lead to confusion and uncertainty. It may lead to the wrong course of action. Our second-opinion process may therefore be unnecessary or misleading, and is in reality not worth much.

"The key to finding an initial exemplary specialist whose first opinion can be trusted is to have that specialist identified by another knowledgeable physician who represents the patient's interests. Such a 'physician trustee' can be a primary care physician with whom the patient has a solid relationship. Alternatively, it can be a physician who is a friend, relative, or acquaintance. In either case, the physician-trustee has to take the time and make the effort to identify specialists he knows in the field in which the patient needs care."

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