New Ways For Patients To Get A Second Opinion.
For many patients, it has become a routine part of
the medical process: Get a diagnosis or treatment
plan and then seek a second opinion.
A growing number of online services are offering
second opinions and some are seeing increasing
patient demand for a second set of eyes.
Some of the services are sponsored by established
medical centers, including Massachusetts General
Hospital and Cleveland Clinic. Others are
independent businesses that work with specialists on
a consulting basis. Employers increasingly are
contracting with such services, and insurance
companies at times require patients to get a second
opinion, such as for surgery.
Studies show as much as 20% of patients seek
second medical opinions; in specialties such as
oncology, the rate is more than 50%. And recent
research has found that second opinions often result
in different diagnoses or treatments.
Second-opinion services are “one of those areas that
is growing fairly quickly,” said Gregory Pauly, chief
operating officer of the Massachusetts General
Physician Organization at Massachusetts General
Hospital. The hospital’s online second-opinion
service, which started about eight years ago, handled
about 10,000 cases last year compared with fewer
than 1,000 five years ago, he estimated. The growing
demand for second opinions, which cost between $
500 and $5,000 depending on the case, has come
from patients, including people from overseas, and
companies that are including the service as part of
employee benefits, he said.
Dr. Pauly said opinions are most often requested in
areas such as cancer, neurosurgery, cardiology and
orthopedics.
Patients can request their medical records be sent to
an online second-opinion service, which might order
additional tests if needed. The services are especially
helpful for people who live far from major academic
centers that cover a range of physician specialties.
Many insurance policies cover in-person second
opinions but don’t pay for online services unless they
are offered as part of an employee’s health plan.
Some experts say patients should seek a second
opinion outside of their normal institution or health-
care network. “There are sometimes internal cultural
approaches to treatment and it’s probably necessary
for patients to go outside to get a new approach,”
said F. Marc Stewart, president of the Patient
Advocate Foundation, a nonprofit that helps patients
access medical care. However, transferring care to
another doctor can be challenging if the doctor is out
of a patient’s insurance network, said Dr. Stewart, a
medical oncologist and medical director of the
Seattle Cancer Care Alliance.
For patients faced with a serious or life-threatening
illness, second opinions might steer them to different
treatment opportunities that are less invasive, have
fewer side effects or are more targeted to their
particular circumstance, said Beth Moore, executive
vice president of program strategy for the Patient
Advocate Foundation, “You don’t always know what’s
available unless you seek a second opinion,” she
said.
Ms. Moore said in-person second opinions are better
in cases that may require sophisticated tests, such as
with rare diseases. When two doctors have divergent
recommendations, she recommends getting a third
or even fourth opinion.
“Patients are often fearful that their physician will be
offended” when seeking a second opinion, said Ms.
Moore. “We’ve found that not to be the case. You’re
going to want the experts to discuss your case in an
open way once the second opinion has been issued.”
Easily diagnosed conditions, such as sinusitis or
shingles, don’t call for a second opinion. But second
opinions can be important when symptoms don’t go
away despite treatment; when diagnosis is unclear or
appears to involve a serious or rare condition; or
when treatment options are risky or harmful, said
Hardeep Singh, a patient safety researcher at Michael
E. DeBakey Veterans Affairs Medical Center and
Baylor College of Medicine in Houston.
A recent study Dr. Singh co-authored looked at data
from Best Doctors Inc., an independent service that
offers second opinions online to companies and
insurance carriers that offer them as a benefit. The
researchers reviewed 6,791 second opinions; there
were changes in diagnosis 14.8% of the time and
changes in treatment 37.4% of the time.
About 60% of the patients ended up following the
recommendations from the second opinion,
according to the study, published in April in the
American Journal of Medicine. However, Dr. Singh
said, “we don’t know whether the ultimate diagnosis
for these patients ended up being the correct one.”
SecondOpinionExpert Inc., a website based in Dana
Point, Calif., that launched this spring, says it
provides second opinions for $300 and the option for
a video conference consultation for an additional $
200. The fees generally aren’t covered by insurance
plans.
Some patients can take the process to extremes, said
Mark Urman, the company’s vice president of
physician relations and quality assurance. “You have
to be careful, you can sometimes get too many
opinions and all it does is confuse you more and then
you don’t know what to do,” said Dr. Urman, who is
an attending cardiologist at Cedars-Sinai Heart
Institute in Los Angeles.
Dr. Urman said most of his patients who seek second
opinions are those for whom he has recommended a
procedure or surgery that is elective. When a patient
comes to him for a second opinion, about 75% of the
time his opinion will be similar to the previous
doctor, he said.
Cleveland Clinic set up an online second-opinion
service, MyConsult, more than a decade ago. In
recent years, the number of patients served has
grown 15% to 25% a year, boosted especially with
patients who live far from the clinic and with
corporate clients. MyConsult charges $565 for a
consultation and $745 if it includes a pathology
review.
Cleveland Clinic doctors who review cases disagree
with the original diagnosis about 11% of the time,
said Jonathan Schaffer, managing director of
MyConsult and an orthopedic surgeon. They make
moderate changes to treatment in 24% of cases and
major changes in 16% of cases. “These numbers can
have some pretty significant health-care
implications,” said Dr. Schaffer.
Linda Smith, a 67-year-old in New Albany, Ohio, was
diagnosed last year with a precancerous lump in her
breast. She had it surgically removed and underwent
five weeks of radiology treatments. When her doctor
then recommended she take a chemotherapy pill,
Ms. Smith sought a second opinion through
Cleveland Clinic’s MyConsult, which was included in
her employee health insurance.
The MyConsult pathologists determined Ms. Smith
had had a different type of precancerous lump than
was originally diagnosed, she said. They told her she
hadn’t needed the five weeks of radiology treatments.
To resolve the conflicting viewpoints, Ms. Smith
sought a third opinion, not covered by her insurance,
that concurred with the MyConsult diagnosis. “I
missed all this work and I missed this key training,”
said Ms. Smith, a design engineer for a
telecommunications company.
Ms. Smith said in the future she will always seek
additional medical opinions, even if she has to pay
for it. “Doctors make mistakes and medicine is
always changing,” she said
HOW TO GET A SECOND OPINION
Second opinions generally aren’t needed for easy-to-
diagnose cases, such as sinusitis or shingles, experts
say. Save second opinions for conditions where a
diagnosis is unclear, involves a serious or rare
condition or when treatment options are risky.
Most doctors expect and encourage second opinions.
Being open and honest with your primary physician
that you want another viewpoint will help should you
later need the experts to discuss your case together.
If possible seek a second opinion from a doctor or
specialist in a different institution or network.
Institutional cultures are real so it’s good to get an
outside and different perspective.
Getting a second opinion that confirms the first
opinion can be reassuring to patients.
If your first and second opinions differ, consider
getting a third or even fourth opinion. But getting
more than that may just end up causing confusion.
In many cases an online second opinion will suffice,
although insurers generally don’t cover them unless
they are included in your employee benefits. For
some conditions, especially rare ones, an in-person
visit is best.
the medical process: Get a diagnosis or treatment
plan and then seek a second opinion.
A growing number of online services are offering
second opinions and some are seeing increasing
patient demand for a second set of eyes.
Some of the services are sponsored by established
medical centers, including Massachusetts General
Hospital and Cleveland Clinic. Others are
independent businesses that work with specialists on
a consulting basis. Employers increasingly are
contracting with such services, and insurance
companies at times require patients to get a second
opinion, such as for surgery.
Studies show as much as 20% of patients seek
second medical opinions; in specialties such as
oncology, the rate is more than 50%. And recent
research has found that second opinions often result
in different diagnoses or treatments.
Second-opinion services are “one of those areas that
is growing fairly quickly,” said Gregory Pauly, chief
operating officer of the Massachusetts General
Physician Organization at Massachusetts General
Hospital. The hospital’s online second-opinion
service, which started about eight years ago, handled
about 10,000 cases last year compared with fewer
than 1,000 five years ago, he estimated. The growing
demand for second opinions, which cost between $
500 and $5,000 depending on the case, has come
from patients, including people from overseas, and
companies that are including the service as part of
employee benefits, he said.
Dr. Pauly said opinions are most often requested in
areas such as cancer, neurosurgery, cardiology and
orthopedics.
Patients can request their medical records be sent to
an online second-opinion service, which might order
additional tests if needed. The services are especially
helpful for people who live far from major academic
centers that cover a range of physician specialties.
Many insurance policies cover in-person second
opinions but don’t pay for online services unless they
are offered as part of an employee’s health plan.
Some experts say patients should seek a second
opinion outside of their normal institution or health-
care network. “There are sometimes internal cultural
approaches to treatment and it’s probably necessary
for patients to go outside to get a new approach,”
said F. Marc Stewart, president of the Patient
Advocate Foundation, a nonprofit that helps patients
access medical care. However, transferring care to
another doctor can be challenging if the doctor is out
of a patient’s insurance network, said Dr. Stewart, a
medical oncologist and medical director of the
Seattle Cancer Care Alliance.
For patients faced with a serious or life-threatening
illness, second opinions might steer them to different
treatment opportunities that are less invasive, have
fewer side effects or are more targeted to their
particular circumstance, said Beth Moore, executive
vice president of program strategy for the Patient
Advocate Foundation, “You don’t always know what’s
available unless you seek a second opinion,” she
said.
Ms. Moore said in-person second opinions are better
in cases that may require sophisticated tests, such as
with rare diseases. When two doctors have divergent
recommendations, she recommends getting a third
or even fourth opinion.
“Patients are often fearful that their physician will be
offended” when seeking a second opinion, said Ms.
Moore. “We’ve found that not to be the case. You’re
going to want the experts to discuss your case in an
open way once the second opinion has been issued.”
Easily diagnosed conditions, such as sinusitis or
shingles, don’t call for a second opinion. But second
opinions can be important when symptoms don’t go
away despite treatment; when diagnosis is unclear or
appears to involve a serious or rare condition; or
when treatment options are risky or harmful, said
Hardeep Singh, a patient safety researcher at Michael
E. DeBakey Veterans Affairs Medical Center and
Baylor College of Medicine in Houston.
A recent study Dr. Singh co-authored looked at data
from Best Doctors Inc., an independent service that
offers second opinions online to companies and
insurance carriers that offer them as a benefit. The
researchers reviewed 6,791 second opinions; there
were changes in diagnosis 14.8% of the time and
changes in treatment 37.4% of the time.
About 60% of the patients ended up following the
recommendations from the second opinion,
according to the study, published in April in the
American Journal of Medicine. However, Dr. Singh
said, “we don’t know whether the ultimate diagnosis
for these patients ended up being the correct one.”
SecondOpinionExpert Inc., a website based in Dana
Point, Calif., that launched this spring, says it
provides second opinions for $300 and the option for
a video conference consultation for an additional $
200. The fees generally aren’t covered by insurance
plans.
Some patients can take the process to extremes, said
Mark Urman, the company’s vice president of
physician relations and quality assurance. “You have
to be careful, you can sometimes get too many
opinions and all it does is confuse you more and then
you don’t know what to do,” said Dr. Urman, who is
an attending cardiologist at Cedars-Sinai Heart
Institute in Los Angeles.
Dr. Urman said most of his patients who seek second
opinions are those for whom he has recommended a
procedure or surgery that is elective. When a patient
comes to him for a second opinion, about 75% of the
time his opinion will be similar to the previous
doctor, he said.
Cleveland Clinic set up an online second-opinion
service, MyConsult, more than a decade ago. In
recent years, the number of patients served has
grown 15% to 25% a year, boosted especially with
patients who live far from the clinic and with
corporate clients. MyConsult charges $565 for a
consultation and $745 if it includes a pathology
review.
Cleveland Clinic doctors who review cases disagree
with the original diagnosis about 11% of the time,
said Jonathan Schaffer, managing director of
MyConsult and an orthopedic surgeon. They make
moderate changes to treatment in 24% of cases and
major changes in 16% of cases. “These numbers can
have some pretty significant health-care
implications,” said Dr. Schaffer.
Linda Smith, a 67-year-old in New Albany, Ohio, was
diagnosed last year with a precancerous lump in her
breast. She had it surgically removed and underwent
five weeks of radiology treatments. When her doctor
then recommended she take a chemotherapy pill,
Ms. Smith sought a second opinion through
Cleveland Clinic’s MyConsult, which was included in
her employee health insurance.
The MyConsult pathologists determined Ms. Smith
had had a different type of precancerous lump than
was originally diagnosed, she said. They told her she
hadn’t needed the five weeks of radiology treatments.
To resolve the conflicting viewpoints, Ms. Smith
sought a third opinion, not covered by her insurance,
that concurred with the MyConsult diagnosis. “I
missed all this work and I missed this key training,”
said Ms. Smith, a design engineer for a
telecommunications company.
Ms. Smith said in the future she will always seek
additional medical opinions, even if she has to pay
for it. “Doctors make mistakes and medicine is
always changing,” she said
HOW TO GET A SECOND OPINION
Second opinions generally aren’t needed for easy-to-
diagnose cases, such as sinusitis or shingles, experts
say. Save second opinions for conditions where a
diagnosis is unclear, involves a serious or rare
condition or when treatment options are risky.
Most doctors expect and encourage second opinions.
Being open and honest with your primary physician
that you want another viewpoint will help should you
later need the experts to discuss your case together.
If possible seek a second opinion from a doctor or
specialist in a different institution or network.
Institutional cultures are real so it’s good to get an
outside and different perspective.
Getting a second opinion that confirms the first
opinion can be reassuring to patients.
If your first and second opinions differ, consider
getting a third or even fourth opinion. But getting
more than that may just end up causing confusion.
In many cases an online second opinion will suffice,
although insurers generally don’t cover them unless
they are included in your employee benefits. For
some conditions, especially rare ones, an in-person
visit is best.
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