WRITTEN BY Nancy Palermo Lietz, MD
Caroline was a healthy 46 year old diagnosed with breast carcinoma in situ following a radiology biopsy done after an abnormal mammogram. As with many women, she was eager to proceed with treatment and was quickly referred to a surgeon through her primary care with no forethought or research on treatment options. She was scheduled for a lumpectomy and node biopsy only to find out a month later that the cancer was more advanced, and she would require further surgery and treatment. Review of the pathology from the first surgery confirmed an invasive high-grade cancer that would have been better treated with mastectomy, chemotherapy and postoperative radiation. Performing the incorrect surgery only delayed treatment and added more pain and confusion to an already stressful situation.
Caroline is like many patients in that she did not consider a second opinion prior to her surgery. In fact, only one in every five patients seeks a second opinion. This number is fairly constant even when the diagnosis involves cancer or another complicated or serious diagnosis. A 2015 study in the American Journal of Medicine reviewed the outcomes of a National Patient Initiated Second Opinion program from Best Doctors, Inc. It revealed patients only sought second opinions in about 20 percent of cases. When they did, it was most commonly related to treatment options (41 percent) and diagnostic concerns (35 percent). The study found that second opinions resulted in changes in the diagnosis or treatment 41 percent of the time.
Patients generally don’t seek a second opinion because they do not want to upset their current physician, or they are eager to proceed with treatment. Many patients are also concerned that a second opinion will be an extra cost to them. The reality is that most insurance companies encourage second opinions, and the majority cover the cost fully. The more complicated or serious the condition, the more useful a second opinion may be, especially given data suggesting differing opinions.
Many of the top medical centers, like Cleveland Clinic, Johns Hopkins and MD Anderson, offer remote consultations pending the review of a patient’s record. These specialists require a close review of all of the patient’s medical records including physician notes, x-rays, lab tests and pathology. Additional testing should not be necessary unless an inadequate initial workup was done. When such a consultation is made, it often is provided by a specialist in the field. A second set of eyes, especially expert eyes, can only be beneficial. Many of these remote consults are covered by insurance companies, but they may cost the patient up to $1,500 in out-of-pocket costs.
Getting a second opinion does not require the patient to change physicians or accept the advice or treatment of the new physician. Only 61 percent of patients ultimately proceed with the advice given in the second opinion. Even when the experts agree with the initial physician, the patient is offered significant reassurance and peace of mind.
When a patient is faced with a confusing, complicated or serious diagnosis, a second opinion can serve to optimize outcomes and further educate the patient on his or her situation. An informed patient is always better off in the long run.