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Health 2.0 Europe 2011 programme
Health 2.0 Europe 2011 programme
Home Second Opinion
Online Medical Second Opinion Service by Certified Physicians

Medical knowledge is expanding rapidly, making it difficult for any one physician to be aware of all the latest information.  As a result, many patients feel the need to seek a second opinion, especially when it comes to important and life-changing decisions related to their health. At Telemed Providers, we understand that it is the patient's right to seek a second opinion and we help patients by presenting them with the opportunity to acquire second opinions on their health condition from world-renowned specialists.

Telemed Providers through its reputed online second-opinion service has made it easy for the local patients to get an expert interpretation on fraction of cost and the technology has made it possible to do that without the need to travel or being present with a physician physically. Now the routine care can be sought out through our telemedicine setup -- and the choice of potentially life-threatening delays in obtaining expert second opinion or forgoing such consultation in emergency cases has become lot easier.

With three easy steps, you can get a second opinion at the comfort of your home

  • Select Specialty & Register
  • Answer questionnaire or upload image
  • Get your second opinion report

It’s that simple. For the patient’s in the Arabic spoken countries such as Saudi Arabia, Kuwait, United Arab Emirates, Qatar, Bahrain, Oman etc, we provide complete assistance in language difficulty and provide the report in Arabic language as well, please ask us for that service.

Please contact us for your second opinion needs and we will send you complete information on how to access our online portal for getting second opinion.

Meanwhile, below is a comprehensive information pack on everything you need to know about second opinion. We put this extensive write-up for those who want to read in depth about how second opinion works and how is it beneficial for both patients and governments to cut costs in this changing economical world. Please enjoy reading and do contact us for any question you may have using our contact us page.

When to Get a Second Opinion

Second opinions are usually not necessary for minor health problems which present little problems in way of diagnosis and treatment. There are certain situations though in which getting a second opinion might be a good idea. These include:

  • If you are diagnosed with a life-threatening disease such as cancer.
  • Before having major surgery, especially if your surgeon has not made it entirely clear why you need the surgery of if you would like to know if options other than surgery are available to treat your condition.
  • When facing a health problem that has been difficult for your regular doctor to diagnose.
  • If you have difficulty talking to your current doctor(s).
  • If you have multiple medical problems which have been difficult to manage by your current doctor(s).

Benefits of Getting a Second Opinion

Getting a second opinion can bring many benefits to patients:

  • It can lead to a more accurate diagnosis of your health condition, especially in complex cases when multiple factors are at play.
  • It gives you more knowledge about your condition and the treatment options available.
  • It can help with your peace of mind and reassure you that you are making the right decision.
  • It can introduce you to new treatment options available and help you understand them.

Your Health, Your Wallet, Your Second Opinion

Getting a second opinion is an option that is available to/for anyone who may have a medical inquiry and/or concern. Its impact stretches far across the medical sphere in terms of what it can do in leading patients to firmer diagnosis and treatment plans, and ultimately in curbing overall medical expenses and health care. The impact second opinions can have on diagnosis within the fields of radiology, surgery, and pathology have been well accounted for. However, the real value of patient-driven second opinions for diagnosis and treatment in general medical practice is still a mystery. In order to fully grasp the magnitude second opinions can have on the above mentioned areas of medicine, it is critical to inspect their direct relationship to clinical outcome(s), patient satisfaction, and overall medical costs and billing. Using research and statistics gathered and presented by the Mayo Clinic, an offering into the effects second opinions can have on diagnosis, treatment, patient satisfaction, and medical expenses is realized.

Patients and Methods:

Within their studyPatient-Initiated Second Opinions: Systematic Review of Characteristics and Impact on Diagnosis, Treatment, and Satisfaction,” the Mayo Clinic notes that second opinions usually reaffirm the original diagnosis or treatment plan; yet about 90 percent of patients who have been given cryptic or poorly defined conditions of their disease/illness go undiagnosed. Furthermore, on a wide scale of 10 to 62 percent, second opinions result in major changes to either the diagnosis, course of treatment, prognosis, or in some cases all three. A higher number of patients receive varying advice on treatment plans than on the diagnosis itself. Reasons behind obtaining a second opinion can range from diagnosis or treatment confirmation, dissatisfaction with a consultation, desire for more information, persistent symptoms, or treatment complications. From a general standpoint, most patients believe getting a second opinion is worthwhile. Yet the available information on patient-initiated second opinions is limited, and the accuracy of the second opinion through follow-up remains a blurred line. Therefore standardized methods and outcome measures are needed to determine and assess the value of second opinions, and the potential of second opinions to reduce diagnostic errors calls for more rigorous evaluation and analysis.

Now patients look to acquire a second opinion if/when their original diagnosis is ambiguous, or is in need of clarification, or when they are presented with an assortment of treatment options that include a certain amount of unpleasantness, complication, or risk. What’s more is that according to a survey, 1 in 6 patients who saw a medical professional within this past year pursued a second opinion, including almost half of cancer survivors. The Mayo Clinic evaluated around 71,811 cases and discovered 457 major discrepancies (0.6%) almost all of which had an impact on diagnosis and treatment. A review of 13 smaller studies indicated relatively higher discrepancy rates of 1.3 to 14.7 percent. The experience and expertise of the pathologists involved and the type of specimen and cancer reviewed could affect the discrepancy rate, with higher error rates (in the range of 10%-15%) encountered in lymphomas, sarcomas, and cancers of the brain, skin, and female reproductive tract. In pathology, follow-up efforts to confirm the value of second opinions have been made. For example, follow-up biopsies in 86 of the 457 cases of discrepancies in the Mayo study revealed that the second opinion diagnosis was confirmed in 73 cases, however in 13 cases (15%), a new diagnosis was found or results were more consistent with the original diagnosis. Likewise, a follow-up study of second opinions on fine-needle thyroid aspiration cytology showed that in 7 percent of cases, neither the first nor the second diagnosis was adequate. These studies emphasize that second opinions could themselves be prone to error.

In the field of radiology, discrepancy rates upon second reviews are typically less than 5 percent for diagnostic studies. Additionally, in a large study carried out by the RADPEER program of the American College of Radiology involving 14 different institutions and examining over 20,000 second reviews, the overall rate of disagreement was posited at 2.9 percent. Second reviews of mammography studies have pointed out that around 10 to 20 percent of malignant tumors are practically missed upon first review. Furthermore, in research-type environments where radiologists are requested to review images with a stronger rate of abnormalities than would be seen in normal proceedings, even higher rates of discrepancy were noted; usually within the range of 20 to 40 percent. The study also showed radiologists to contest their own previous readings one-third of the time.

Aside from these diagnostic specialties, the effect and possible advantage of second opinions for general medical, surgical, financial conditions has not been aptly examined or determined. And because of the growing popularity of second opinions, it is imperative to discern to what extent does this medical option improve overall quality of patient care and whether it varies for different medical conditions. Likewise, little is known surrounding what motivates patients to seek a second opinion and whether they are indeed satisfied by the outcome(s). And with the continuing recognition of diagnostic errors in medicine, projected at 10 to 15 percent of all cases, getting a second opinion has been hailed as a viable, pragmatic means a patient could use to help significantly reduce any chance of further diagnostic error.

Data Collection and Analysis:

By using a handful of data bases, assessing the potential risk of 7 biases using the Cochrane Risk of Bias Tool, and rating the quality of the study by using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Database searchers from the Mayo Clinic recognized 1336. During the initial screening phase, 129 potentially meaningful abstracts were discovered, with 41 of them fulfilling the inclusion criteria (see figure below).

Medical Second Opinion service

Of these 13 articles, 7 had data on whether the second opinion was in consensus with the original diagnosis and 10 articles comprised of data on patient motivation, characteristics, and overall satisfaction (see attachment of Tables 1 and 2).

Second Opinions on Cancer:

Based on the results drawn from Table 2: when it comes to second opinions regarding cancer; Mellink et al of New Zealand studied a sequence of 403 successive patients in search for a second opinion within the cancer clinic. Most of the patients (83%) were women. Around 83 percent of them having breast cancer, with 20 percent of all women experiencing metastasis of the disease. The review comprised of second opinions of histologic, cytologic, and radiologic diagnostic tests and review by an oncologist. Furthermore, 317 patients where the second opinion was comparable with the original diagnosis, there existed no perceivable change in 68 percent of cases reviewed. There existed a minor discrepancy in 16 percent and a major discrepancy (defined as a significant change in treatment and/or prognosis) in another 16 percent. Of the 321 cases where pathology slides were put under review, disagreement was recorded in 11 (3%), while in 247 cases where imaging studies were reviewed, 4 reviews (2%) lead to major changes. Based on study released by Tattersall et al of Australia, 77 patients obtaining a second opinion from a medical oncology clinic noted a significant change in treatment for 32 (42%) of them. Additionally, a study by Ramsey et all of the United States found that second opinions in 143 men with local-stage prostate cancer, the second opinions were more in favor of surgery (91% as opposed to 71% from the original opinion) over alternative treatment choices.

Second Opinions on Elective Surgery:

Segueing from those figure into second opinions when it comes to elective surgery: in the Cornell Elective Surgery Second Opinion Program, around 4555 patients participated at their own will. A third of the cases (34%) posited the second opinion to disagree with the pursuit of surgery, deeming it unnecessary. The bulk of these second opinions were tied to possible orthopedic and gynecologic surgeries.

Second Opinions for General Medical Concerns:

Second opinions for general medical concerns were reflected in a study by Sutherland and Verhoef, of Canada, where 19 patients pursued a second opinion for gastrointestinal symptoms. The studies discoveries revealed total consensus with the referral assessment in 12 (63%) patients and relatively low disagreement within the remaining 7 (37%). The same researchers exhumed the study for a second time, five years later, in order to draw comparisons from the previous study. Within their new study they found that the number of patients who want a second opinion increased from 7.5 percent in 1989 to 16 percent in 1994. In 1989 it was revealed that it was the patients’ independent decision to seek a second opinion rather than act on a recommendation by their original physician; yet this figure decreased to 43 percent by 1994. Patients who wanted a second opinion to confirm a diagnosis or course of treatment rose from 30 percent to 42.85 percent. Moreover, in a study conducted by a general medical clinic in the Netherlands, 201 patients, most of which (86%) were put under second review for common symptoms such as fatigue (34%) and abdominal pain (27%). Yet, no final diagnosis appeared over the reevaluation period in 90 percent of the cases, as totally new diagnoses were found in just 10 percent of the patients. Lastly, in a study conducted by Wijers et al, of Amsterdam, 62 percent of 183 patients seeking a second opinion on a neurological condition received a new diagnosis and/or treatment advice.

Impact of Second Opinions on U.S. Health-Care:

The global impact of second opinions is made quite apparent in tables 1 and 2. Second opinions could have the same impact when it comes to overall costs and medical expenses in the United States. In 2012 it was estimated that more than $2.5 trillion in total made up the U.S. health care cost(s) which accounted for 18.2 percent of the overall GDP. The figure has naturally risen since then and therefore must be addressed; for superfluous healthcare costs take major chunks out of wages, significantly diminishes global competitiveness, and can eventually lead to a bankrupt government. Unfortunately, the healthcare situation on the U.S. has only regressed as the government seeks to cut back on its hospital spending causes medical institutions and professionals to charge patients with private insurance more in order to make up the difference. The U.S. healthcare system has been said to be ripe with abuse as insidious trends such as doctors overprescribing costly procedures in an attempt to raise their own profits is still a common accusation. As hospitals are not mandated to post quality metrics that would assist patients in making informed decisions on where to get care, how to get care, and how much to get care for has led to a quality of care that comprises of excessive, costly procedures. One way to curb expenses is by focusing on the 6-8 percent of employees who incur about 80 percent of health costs. Living in a time where it can cost up to $1 million for a given procedure can be overwhelming. The downside is most of these procedures, around 10-20 percent, could be handled more efficiently; but are not due to a misdiagnosis as research complied by John Hopkins shows that over the past 25 years, diagnostic errors have accounted for nearly 29 percent of insurance claims at a cost of $40 billion, and more often have resulted in death. Additionally, poor selection in treatment and surgical options contribute to excessive health costs. Therefore, it would behoove businesses to mandate that their employees receive second opinions to help track their outcomes more methodically. Quality of care naturally leads to a drop in costs. Lowe’s company is a good example of this as they have developed a contract with the Cleveland Clinic to obtain second opinions in the case of cardiac surgery. And while some patients may be reluctant to acquire a second opinion, their stance could be easily swayed once they realize it has the potential of saving them from an unnecessary, highly expensive, invasive procedure. Medical centers such as Johns Hopkins, Cleveland Clinic, Partners HealthCare and MD Anderson offer second opinion services. Johns Hopkins charges $565 to review a case, and $250 to interpret an image.

Cutting costs would certainly be satisfactory to patients across the board. Second opinions can offer satisfaction to patients, yet until the report released by Mayo Clinic, no one has factored in the numbers behind patient satisfaction. As noted in the report, a large majority of those patients who sought a second opinion were women (66-82%) with a median of 54 years of age and usually requesting a second opinion regarding breast cancer. In contrast, patients with general medical conditions usually had persistent symptoms and extended disease durations (rheumatologic, 6 years; neurologic, 5 years; gastroenterologic, 16.7 years) and had received treatment for months (rheumatologic, 4 months; neurologic, 10.6 months; gastroenterologic, 3.7 months).

Patient Motivation(s):

When it came to motivating factors, patients with cancer usually wanted supplemental information regarding their disease (33-89%), its treatment (70-97%), or prognosis (93%). A good number of patients ( 17%, 61%, 68%) wanted reassurance that their diagnosis and/or treatment was correct, while 68 percent wished for a change in their diagnosis. Additionally, almost half (46%) of patients with cancer pursued a second opinion due to complications of treatment. One-third (30-38%) had needs that were not being met and/or negative experiences with their original physician; 27 percent of which experienced issues of communication. Over half (55%) of patients displayed a sense of loyalty to their original physician when deciding on getting a second opinion; 47 percent did not want to insult or upset their first doctor by seeking a second opinion. In patients with cancer, indicators of pursuing a second opinion comprised of tertiary-level education, radiation therapy, and late-stage disease.

Patient Satisfaction:

Within the bulk of the report it was noted that patients usually were unsatisfied with the first opinion, leading them to obtain a second. For patients with cancer, satisfaction was strongly connected to the reaffirmation of the original diagnosis and treatment plan, the conduct of the physician, and the patient’s own involvement in any decision making throughout the process. A study from Australia showed that patients with cancer who obtained a second opinion from another oncologist regarding their case, gave them a higher sense of confidence (53%); and addressed all of their concerns (51%), in addition to spending more time communicating with them than their former physician (47%). Another study evaluated the satisfaction of nomadic patients; 30% of those with rheumatologic, 14% of those with gastroenterologic, and 14% of those with neurologic problems were quite satisfied upon getting a second opinion on their respective disease(s). While in another study, the satisfaction of patients with neurological symptoms was not directly linked to a new diagnosis or treatment advice, but rather with the amount of information and emotional support given by the second neurologist.

Conclusion:

In conclusion, it is evidently clear that numerous factors account for overall patient satisfaction when it comes to second opinions. Most patients perceive second opinions to hold a tremendous amount of value to them, as do hospitals and businesses with the examples of John Hopkins and Lowe’s; as a second opinion can offer reassurance in the original diagnosis or provide guidance when the diagnosis/treatment plan is askew.

Result Tables:

An overview of the articles discussing characteristics, motivation, and satisfaction of patients seeking second opinions is presented in Table 1. These studies assessed cancer and general medical conditions across the domains of general internal medicine, neurology, gastroenterology, and rheumatology:

Table 1 Article Characteristics

Clinical outcome agreement

Reference, year

No. of patients

Diagnosis

Treatment

Prognosis

Grafe et al,33 1978

4555

X

Mellink et al,34 2006

403

X

X

X

Mustafa et al,35 2002

201

X

X

Wijers et al,36 2010

183

X

X

Ramsey et al,37 2011

143

X

Tattersall et al,38 2009

77

X

Sutherland & Verhoef,39 1989

19

X

 

Table 1 Article Characteristics

Summary of articles by category

Description (reference)

Cancer, 3 studies

Breast, digestive, melanoma, sarcoma, unknown primary, other (Mellink et al,34 2006)

Cancer in various locations (Tattersall et al,
38 2009)

Prostate cancer (Ramsey et al,
37 2011)

Elective surgery, 1 study

Orthopedic, cataracts, cholecystectomies, hysterectomies, other (Grafe et al,33 1978)

General medical concerns, 3 studies

Fatigue, abdominal pain, chest pain, miscellaneous (Mustafa et al,35 2002)

Gastroenterology (Sutherland & Verhoef,
39 1989)

Neurology (Wijers et al,
36 2010)

 

Table 1 Article Characteristics

Patient characteristics, motivation, satisfaction

Reference, year

No. of patients

Characteristics

Motivation

Satisfaction

Bekkelund & Salvesen,40 2001

927

X

X

X

Sutherland & Verhoef,41 1994

341

X

Boudali et al,42 2012

250

X

X

X

Mellink et al,43 2003

212

X

X

Mustafa et al,35 2002

201

X

Tam et al,44 2005

191

X

X

Wijers et al,36 2010

183

X

X

Tattersall et al,38 2009

77

X

X

X

Sutherland & Verhoef,39 1989

19

X

X

Philip et al,45 2010

17

X

X

X

 

Table 1 Article Characteristics

Summary of articles by category

Description (reference)

Cancer, 4 studies

Breast, digestive tract, melanoma, sarcoma, unknown primary, other (Mellink et al,432003)

Cancer in various locations (Tattersall et al,
38 2009; Philip et al,45 2010)

Gynecology (Tam et al,
44 2005)

General medical concerns, 6 studies

Gastroenterology (Sutherland & Verhoef,41 1994; Sutherland & Verhoef,39 1989)

Neurology (Bekkelund & Salvesen,
40 2001; Wijers et al,36 2010)

Rheumatology, gastroenterology, neurology (Boudali et al,
42 2012)

Various diseases (Mustafa et al,
35 2002)

All 13 of the qualifying articles used an observational design, corresponding to a Cochrane GRADE quality score of “low” or “very low. Bias scores were typically high, reflecting lack of randomization, unblinded study formats, small number of patients, single study sites, lack of control groups, and the use of evaluation instruments lacking validation. The agreement between reviewers for risk of bias and study quality was 64.4% and 69.2%, respectively.

Studies Reporting Clinical Agreement:

Results from the 7 articles reporting data on clinical agreement are presented in Table 2. The studies describe 3 types of patients: those with cancer, those seeking a second opinion about elective surgery, and patients with other general medical concern.

Table 2: Patient-Initiated Second Opinions: Clinical Agreement

Reference, year, location

Setting, methods

Results, impact

Study quality

Cancer

 Mellink et al,34 2006, Netherlands

Patients with cancer seen in a medical oncology clinic dedicated to providing second opinions

Of 317 patients evaluated, a major change in the diagnosis, treatment, or prognosis was identified in 16% and no change in 68%. Pathology material was reviewed in 321 cases, with a major change identified in 11 (3%); imaging was reviewed in 247 cases, with a major change in 4 cases (2%)

Low

 Tattersall et al,38 2009, Australia

Patients with cancer seen in a medical oncology clinic

Of 77 patients evaluated, the treatment plan was changed in 32 (42%); 29 patients changed managing physicians (38%)

Low

 Ramsey et al,37 2011, United States

Men with local-stage prostate cancer seen for treatment advice in an academic urology clinic

Of 143 men, 28 (20%) were encouraged to have surgery compared with previously recommended options

Low

Elective surgery

 Grafe et al,33 1978, United States

Patients obtaining a second opinion on suggested elective surgery

Of 4555 patients evaluated, the elective surgery was thought to be unnecessary in a third (34%)

Low

General medical concerns

 Sutherland & Verhoef,391989, Canada

Patients with abdominal complaints evaluated in an academic gastroenterology clinic. Physicians assigned a score on a 5-point scale to differentiate functional from organic etiologies

Of 19 patients evaluated, there was complete agreement with the referral assessment in 12 (63%), and in the remaining 7 (37%), the score differed by just 1 point

Low

 Mustafa et al,35 2002, Netherlands

Patients with chronic unresolved symptoms or treatment issues seen in a general medicine clinic

Of 201 patients evaluated for undiagnosed conditions, a new diagnosis was established in 10%. Of 31 patients evaluated for treatment issues, a treatment change was advised in 22 (71%)

Very low

 Wijers et al,36 2010, Amsterdam

Patients visiting a neurology academic center

Of 183 patients, 113 (62%) received a new diagnosis and/or treatment advice

Low