Commentary: In a recent interview with the NY Times, actress Rita Wilson shined a bright spotlight on the topic of medical second opinions. The Broadway star and mother of four, who is also married to actor Tom Hanks, received a second opinion that provided her with much-needed answers and guidance through a breast cancer diagnosis.

In a study being published by the American Journal of Medicine, researchers sought to understand why patients sought second opinions, how often a change in diagnosis or treatment plan was recommended, and the level of satisfaction experienced by patients. Upon analyzing nearly 7,000 second opinions made available to individuals through an employer-sponsored benefit, the authors of the study verified a significant impact on diagnosis and treatment for a large number of patients.

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The statistical and anecdotal benefits of second opinions underscore their importance in decreasing misdiagnosis and optimizing treatment plans. However, questions remain: Are all second opinions created equal? What should employees know before, during, and after a second opinion?

Collaboration

Encourage employees to speak with their primary care physician about seeing another specialist for evaluation.  Although obtaining second opinions is now commonplace in medicine and most specialists appreciate their value, many patients are more comfortable making this request with their PCP. Employees should not be reluctant to ask for a second opinion. The collaboration between a primary care physician and second opinion provider is critical to deciphering symptoms and ensuring that ongoing care is carefully coordinated. A primary care physician can also help collect key records and provide them to the second opinion specialist prior to a visit.

Availability

In addition to traditional second opinions, in-depth remote second opinions are also readily available to millions of people in the US. Many of the world’s leading employers offer expert second opinions as a valued employee benefit that can save health care dollars by averting unnecessary or even harmful testing and treatment, decrease absenteeism, and promote employee retention. Employers should be proactive in reminding their teams of these services and encouraging anyone with medical uncertainty to take advantage of them. These services dedicate a large amount of effort to synthesizing all medical records and providing access to leading physicians at major medical institutions of excellence. Taking enough time to synthesize and review each case is extremely important, as even excellent doctors can miss key information when harried by the time pressures faced by most U.S. physicians.


Retest

A recent study in the Journal of the American Medical Association found that biopsies, which have long been the gold standard in breast cancer identification, may not be as reliable as we originally imagined due to common errors in how the pathologies are read. The studied estimated that as many as 25% of breast pathologies could be misread.

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If you have employees with care that involved getting a biopsy or other tissue specimen, provide resources to have the pathology reviewed at a center with specialized pathology departments (for example, a dedicated GI pathology department).  These specialized pathologists bring a wealth of experience that can make the difference between an accurate diagnosis and an incorrect one.  A treating specialist can help initiate this request.

Accuracy

Employees should be reminded that the steps in performing a second opinion can be expedited when necessary, but a high quality, thorough second opinion is preferable to a quick yet superficial one; speed can be seductive, but accuracy is life-changing. Collecting all records, carefully scouring those records, retesting pathologies, and collaborating with leading physicians is well-worth doing when they face medical uncertainty. For complex and serious conditions like cancer, multiple sclerosis, auto-immune disorders, and chronic pain syndromes there are often many years of history that are critical for diagnosis, and corners cannot be cut. 

Medical uncertainty and misdiagnoses occur for numerous reasons – but among the most important is that modern medicine is highly complex, yet doctors are working in a system where they are often forced to make a diagnosis in a compressed amount of time with a limited set of information. Mistakes are bound to happen. In this setting, second opinions provide a practical and impactful solution. Employers play a key role in this process as facilitators and sources of information and options. Be sure that there is collaboration between physicians, a careful collection of all medical records, retesting of pathologies, and an emphasis on accuracy. As Rita Wilson’s case demonstrates, a second opinion can be life-saving.

Dr. David Harrison is an attending physician at Massachusetts General Hospital and medical director at Best Doctors, Inc., a global health company that uses analytics and technology to help people get the right diagnosis and treatment. 

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