Doctors' Love/Hate Relationship With Second Opinions

Neil Chesanow

Disclosures

June 18, 2015

In This Article

Choosing the Best Doctor for a Second Opinion

In reality, though, locating an "exemplary specialist" is easier said than done. Even finding the right specialist with a solid reputation in the community, let alone a key opinion leader who may not practice in the same part of the country, involves a lot of work for the referring physician.

"Who's going to take responsibility for that?" asks Dr Varn of PinnacleCare. "The patient doesn't know what to do. They're not skilled or versed in the healthcare system. Yet the physician, who needs to move on and see six more patients that afternoon, really doesn't have the time to organize the records, present the questions that need to be presented, make the referral, and make sure the patient gets to the right experts. It's not an easy process. It creates more work that physicians don't have time to do."

A growing number of hospitals and private firms are stepping in to make the process easier by arranging for specialists to offer second opinions from afar. Johns Hopkins Medicine in Baltimore, Maryland, for example, will arrange for a remote second opinion with a specialist in their departments of dermatology, gastroenterology and hepatology, neurology and neurosurgery, neuroradiology, otolaryngology and head and neck surgery, pathology, surgery, and urology.[6] MD Anderson Cancer Center in Houston, Texas, will arrange for a remote second opinion with a pathologist who is expert in identifying breast, skin, gastrointestinal, genitourinary, gynecologic, head and neck, bone and soft tissue, thoracic, or other cancers.[7] The Cleveland Clinic will arrange for online second opinions for over 1200 conditions.[8]

"Different treatment approaches may be equally valid," Dr Varn points out. "One physician can make a strong argument that their approach is right and present that to the patient. Another physician can make an equally strong argument that their approach, which is different, is right and make that case to the patient. Our job is to make sure that the patient understands the arguments for and against and then makes an educated, thoughtful decision that's right for them."

PinnacleCare, where Dr Varn is medical director, is one of a growing number of private firms that arrange for remote second opinions on behalf of patients, their doctors, and employers. The firm has formed relationships with dozens of top medical centers, including Memorial Sloan Kettering Cancer Center in New York; McClean Hospital and Massachusetts General Hospital in Boston; Duke Health in Durham, North Carolina; Rush University Medical Center in Chicago, Illinois; Mayo Clinic in Scottsdale, Arizona; and Cedars-Sinai Medical Center in Los Angeles, California.[9]

Medical experts working through such institutions do not have hands-on contact with patients. After examining patient records and the results of tests conducted elsewhere—or, in the case of pathology, often reanalyzing tissue samples—a specialist issues a report that is then posted online, accessible to patients via a secure web portal. In some cases, a representative of the organization discusses the report with a patient over the phone.

In-person second opinions are generally covered by commercial insurance. Medicare Part B foots the bill for a second opinion if surgery is recommended—even, in some cases, if the surgery isn't an emergency.[10] The patient pays 20% of the Medicare-approved amount. Medicare will also help pay for a third opinion if the first and second opinions are different. As for virtual second opinions, "I don't know of any insurance company that covers that cost," Dr Varn says.

What is the cost? To give you an idea, the Cleveland Clinic's MyConsult Online Medical Second Opinion service will confirm whether one of its specialists concurs that the initial diagnosis is correct and that the treatment plan recommended by the patient's physician is indeed the best option for the patient for a fee of $565.[11] If pathology is included, the fee is $745. A Cleveland Clinic specialist reviews the case and provides a comprehensive report, which the patient accesses via a special Web portal, in about 10 days to 2 weeks.

"After receiving a report, patients will sometimes ask me, 'What would you do?'" Dr Varn says. "I tell them, 'I can't make this decision for you. My decision would be based on my own beliefs, values, and circumstances. Yours needs to be based on your beliefs and values. I just want to make sure that you understand what you need to know to make an informed decision. That's my job.'"

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