First, Get A Second Opinion

Practice: Patients are encouraged to get second opinions - it could lead to a change in treatment or diagnosis.

Medicine & Science

April 05, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

After suffering an unusual wrist injury that left him unable to use his right hand, Dr. Jerome E. Groopman saw five surgeons at five institutions - and ended up with almost as many opinions.

One doctor wasn't sure what was wrong and wanted to monitor his progress. Another recommended three-stage surgery. Still another believed the patient had torn a ligament and needed a bone graft.

That physician, in the end, turned out to be right. After surgery last August, Groopman has had a near-full recovery.

"Second opinions are critical," said Groopman, professor of medicine at Harvard Medical School, who once had an unsuccessful back operation without getting one. "No doctor is infallible."

Research is scant on how many of today's patients are seeking second opinions, for what reason and to what end. Insurance companies began requiring them in some cases in the 1970s as a means of controlling the costs associated with unnecessary surgeries. But now, experts say, the trend toward getting second opinions is driven more by patients.

Some abuse the practice, "doctor-shopping" until they find one who will tell them what they want to hear. Others are hesitant to seek a second opinion, fearing their first doctor will be offended. Groopman, who wrote a book called Second Opinions, said that, unfortunately, that sometimes happens.

Several studies, though, have shown that having a second set of eyes review your case can often lead to a change in treatment - and even sometimes a change in diagnosis.

"A second medical opinion is like a diagnostic test," said Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, which supported a 1999 study on the topic.

Aided by cyberspace, an increasing number of medical institutions are offering second opinions to patients who never even pass through their doors. Partners HealthCare, which is based in Massachusetts, runs an online consultation program using experts from Massachusetts General Hospital, Brigham and Women's Hospital, and the Dana-Farber Cancer Institute.

"We thought it was a pity that you have to be in the Boston area to take advantage of them," said Dr. Joseph C. Kvedar, director of telemedicine for Partners HealthCare. "We are using the Internet as a vehicle to disseminate that knowledge broadly."

Some physicians criticize the practice, saying it erodes the personal doctor-patient relationship that is so crucial in medicine, but it seems to be catching on. Partners has seen its patient base grow by about 25 percent each year since its launch in 2001, Kvedar said. It arranged about 1,800 "virtual" consultations last year - about half for patients outside the country - and is expecting to do about 2,500 this year.

The cost can range from $225 for having a single radiology report reviewed to $750 or more for a "package" deal, including a specialist consultation and the reading of multiple lab reports.

Kvedar said the majority of patients have cancer or other "life-altering" conditions. Some are at an early stage of their illness, trying to decide which treatment will give them the best long-term chance of survival; others are years into their diagnosis, seeking advice on whether to withdraw from treatment and seek hospice.

Mary Kralis-Hoppe of Boston arranged a second opinion for her father, Jerry Kralis, in September after he was diagnosed at Indiana University Medical Center with cancer that had spread from his kidney to his lungs and elsewhere.

She wasn't certain that bombarding his 75-year-old body with chemotherapy was the right approach, and he wasn't able to make the trip from Indianapolis himself. So Kralis-Hoppe had her father's records sent to an oncologist at Dana-Farber for a second look. The process took about 10 days.

"[The doctor] said, `You know what, I would do the exact same thing,' " she said. "It gave us assurance. I think it made the Indianapolis doctor feel better, too."

Doctors at the Johns Hopkins Hospital also provide second opinions remotely, but only to international patients, in part because of concerns over advising people who live in states where the doctors aren't licensed to practice. Some programs get around that by using another physician - sometimes the one the patient saw initially - as a sort of middleman.

Hopkins received 624 requests for remote second opinions last year, said Liz von Kessler, director of clinical programs and performance improvement at Johns Hopkins International.

Having the consultations allows patients and their families to know whether it's worth making an expensive trip to Baltimore from as far away as South America or Asia, she said.

Getting a second opinion, experts say, isn't always about peace of mind. A team at the University of Michigan Comprehensive Cancer Center reported in December that 7 percent of women diagnosed with breast cancer who sought second opinions were found to have more cancer in the same breast or a previously undetected tumor in the other one.

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