Thursday, April 17, 2008

A Second Opinion on Second Opinions

The idea of getting a second opinion makes a lot of sense, especially in complex cases. However, in practice, it is difficult to broach the topic as it feels like a violation of the trust one hopes develops between a physician and their doctor. However, a recent article on second opinions in the NYTimes shows that second opinions deserve a second look:
Some studies have examined the frequency and efficacy of second opinions related to invasive procedures like biopsy and cancer surgery. Rates of discrepancies between doctors vary, and for the most part they do not lead to changes in treatment. For 30 percent of patients who voluntarily seek second opinions for elective surgery and 18 percent of those whose insurance companies require it, the second doctors disagree with the first.
Thirty percent? That's pretty high, but it makes sense given how complex cases can become. I think one way to approach the problem would be to make second opinions a standard requirement for particular diagnoses that are more likely to have ambiguities, such as how to treat complex hematologic cancers. Doing so might make the practice more acceptable.

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