Second opinions are one of the most under-utilized options for patients in modern medical care. Patients don’t know whether or not they should get a second opinion, what the benefits are, or in what circumstances it’s advisable to seek one.
We sat down recently to discuss second opinions with Dr. Marty Makary, surgeon at Johns Hopkins Hospital, author of the bestselling book Unaccountable, and MEDIGO advisor.
What is a second opinion and why should someone get one?
There are a tremendous number of treatment options a patient can have recommended to them, and the only way to really sift through [them] is to educate yourself.
20-30% of second opinions are different from the first opinion, and up to 15-30% of all medical care administered by doctors – in the opinion of doctors – is unnecessary. We’re talking about unnecessary diagnostic tests, medications, and even surgical procedures.
When a patient is educated, they are a very powerful consumer. I mean, we would consider it very reasonable to know what the different types of car options are, if you buy a car, or the different types of TVs before you buy a TV, but patients will have more information about a refrigerator than they will about their medical care – and we can do better.
In what situations is it advisable to seek a second opinion?
You know, I tell friends and colleagues that when they get medical care for themselves – anytime you’re going to have something major, anytime you’re going to start a new medication every day for the rest of your life – it’s worth getting a second opinion.
What’s the current adoption of second opinions in healthcare today?
Second opinions are the biggest thing in healthcare, in modern medicine, because people know there’s a lot of variation in the recommendations that are made by physicians.
I had this happen recently when I became a patient for something a lot of surgeons have – and that’s heartburn. I went to my doctor, and I asked them, “Is there something we can do about this heartburn?” And they prescribed a medication, and I started taking this medication every day until I learned that a study just came out that the medication can cause stroke and renal failure late in life in some patients, and I thought, “Gosh, I don’t want to be on this thing!” I went to another doctor for a second opinion and they said, “There’s another option – It’s called lifestyle modification.” In other words, eat better, eat at more frequent intervals, and avoid certain foods that [trigger] heartburn. But sure enough it worked, and I’ve never needed the medication again, and I’ve never had the heartburn again.
It is amazing what a second opinion can offer. To think about the costs of this expensive medication – not to mention the risks – long-term, for the rest of my life without really drawing in that second opinion, it would’ve been tremendous.
And to think now, as a doctor, about that power of a second opinion really makes me want to suggest it to patients that are unsure about their options or need peace of mind. Or they are friends or colleagues who are given one opinion, and then they’ll ask me what I think and I’ll often say, “Look this is out of my area of expertise, but I can tell you I’ve become a believer in the power of a second opinion – Not just [with] my own patients, but also in my own personal medical care.”
What factors keep second opinion adoption levels so low?
Why don’t we have more second opinions out there? Well, I get two types of patients that come to my office as a surgeon. One has a stack of Google printouts, asks dozens of questions, and says, “What about this option? What about that option?” The other type of patient walks in and says, “Doc, whatever you say.” They cut me off as I explain the options, and they’ll say, “Look, doc, whatever you recommend – you just tell me what to do.” Now, while [the latter] may make my life a little easier, it’s not good for patient care. Patients need to understand what they’re going to have done, and what their options are.
We can’t fix the messy healthcare system with new government policies, but we can fix it by empowering patients to get educated about their condition and get the best medical care. And I truly believe, and I believe the research supports this, that better care is less costly care. That is best done, in my opinion, through second opinions as the starting point for, at minimum, educating patients about different options.
What is the impact of getting a second opinion on patients?
When a patient gets a second opinion, oftentimes they learn about a different option. I’ve had patients tell me they were never told that not taking the medication had only minimal risks, and avoided a whole host of side effects that they didn’t want to risk. And what we need to do is ask, what’s the right care for you? What’s the right care factoring in a patient’s frailty, a patient’s quality of life, their mood, their goals to live long or live a very healthy life right until the end.
We’re moving towards shared decision making. Rather than recommending something as a reflex, trying to reach a decision with the patient as a partner to say, “What’s best for you?”. There’s no books on how to do that. There’s no hard rules in the pathology textbook that list the indications and treatments accounting for those factors. But what we can say is that it’s good doctoring, and good doctoring is not something that you are guaranteed to get in the first opinion.
I mean, if you look at the cost and the time to get a second opinion, it pales in comparison to the burden and cost and potential risks or benefits to your health of doing something major to your body.
The patient that asks the right questions gets better medical care, hands down, almost every time. Second opinions are a great vehicle to doing that. Without good second opinions, we would have the wild west of medicine. It’s that patient autonomy that really allows us to be able to tell patients, “Here are the different ways of doing things, here’s what the science supports, and here are the risks and potential benefits – Let’s talk about what is best for you.”
Want to learn more about second opinions through MEDIGO? Get in touch!