Second opinionsUncategorized

Second opinions, the unspoken child of medicine

When people ask me “why second opinions?” I have a stock answer – because it empowers! But it is difficult to measure the effects of empowerment in a field where it is notoriously difficult to measure the effect of any intervention at the systems level.

To understand the power that a qualified second opinion could have, one must place oneself in the shoes of a poor mother of a sick child, or a young adult whose parent may no longer be able to support him or her because of an illness. There are important decisions to be made and an independent, skilled and trustworthy opinion would be invaluable to any person, let alone one in a poor and under-served area of the world.

The human argument aside, second opinions play an important role from the perspective of a health policy maker. While many healthcare initiatives aim to build much-needed healthcare infrastructure and train human resources to provide services, second opinions are completely compatible with what exists presently. Such opinions are to be had for virtually no cost other than the consultation fees of a specialist. And importantly, they improve the confidence of the patient in the healthcare infrastructure that is in place. Again a human issue – confidence – but one that is central to the functioning of any system, and one that is recognized by policy makers.

When measuring actual health outcomes there are studies, albeit mainly from the developed world, that have shown both improvements in health of patients as well as cost savings to the system. One can read more about these here.

Healthcare research has however mostly ignored second opinions. Like most medical interventions, the biggest drivers and the highest barriers are the doctors themselves. Few people are openly willing to have their opinions open to scrutiny by their peers and doctors are no exception. Systematically examining the decisions that doctors make is difficult, and support for an intervention that could potentially expose a failing, be it in the system or in the individual, is not easily proffered.

Nevertheless second opinions cannot be ignored. One study showed that up to 40% of all outpatient consultations are second opinions. What is happening here? Are these patients dissatisfied with their current doctors or their advice? Are they merely looking for reassurance? Does it really make a difference to the patient? Do healthcare systems need to be designed to take these into account? The answers are not all there, but what is interesting is that second opinions are universally sought by rich and poor. So any service that tries to provide second opinions will have a demand spread across socioeconomic strata; whether the result is equitable, like in any intervention, will hinge on its design.

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