Skip to main content

Patient-initiated second medical opinions in healthcare

 A second medical opinion is a medical decision-making tool for patients, physicians, hospitals and insurers. For patients, it is a way to gain an additional opinion on a diagnosis, treatment or prognosis from another physician. Physicians seeking another colleague’s opinion may refer a patient to another consultant to gain further advice. Many health insurers mandate second opinion programmes to reduce medical costs and eliminate ineffective or suboptimal treatments. Hospitals may also require second reviews as part of routine pathology, radiology reviews or for legal purposes. consultant to consultant referrals. Patients in primary care may also request an opinion from a second specialist when unhappy with the opinion from the first specialist.

We carried out a systematic review to summarise evidence on (1) the characteristics and motivating factors of patients who initiate second opinions; (2) the impact of patient-initiated second opinions on diagnosis, treatment, prognosis and patient satisfaction; and (3) their cost effectiveness. The reivew was published in BMJ Opinion.

Thirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions.

The review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.

DOI: http://dx.doi.org/10.1136/bmjopen-2020-044033

Comments

Post a Comment

Popular posts from this blog

Protecting Against the "Quad-demic": Influenza, Covid-19, Norovirus and RSV

As the NHS braces for a challenging winter season, it is grappling with a "quad-demic" of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups. The Four Viruses: What Are They? Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions. Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SA...
Post a Comment
Read more

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...
6 comments
Read more

How can we work successfully across the health and care system to make a success of Pharmacy First?

Pharmacies in England to begin treating patients for seven common conditions. How can we work successfully across the health and care system to make a success of Pharmacy First? 1. The Pharmacy First scheme aims to provide convenient access to healthcare through community pharmacies. Patients with minor ailments or common conditions can seek advice and treatment directly from their local pharmacy instead of visiting a general practice, urgent care centre or emergency department. The conditions covered by the scheme may vary depending on local funding arrangements and participation of pharmacies.  2, A potential problem with Pharmacy First is pharmacists misdiagnosing a patient's condition. It may also lead to delays in patients seeing doctors when medical assessment is needed. To mitigate these risks, appropriate safeguards and referral pathways should be established, ensuring timely medical assessment when necessary. The scheme will also increase the workload of pharmacies, thereb...
Post a Comment
Read more