More patients are using these services, but there can be traps…
For many of us, second opinions have become an accepted, almost routine part of medical care. But what may be new to you are the many options for getting high-quality second opinions online.
Why Go Online?
For a second opinion to be truly nonbiased, it should be obtained from a doctor in a medical group and hospital system different from the doctor who made the first diagnosis. The first and second doctor shouldn’t work together professionally or know each other socially. However, in a small town or even a small city, this is often impossible.
Additionally, sometimes the condition in question is so rare or the circumstances so ambiguous that sufficient medical expertise for a second opinion isn’t available locally. A trip to an out-of-town medical center could be made, but sometimes mobility issues, distance, transportation difficulties and expense make this option impractical. In these situations, online second opinions can be a beneficial solution.
What to Do First
Before you seek a second opinion, online or otherwise, it’s important to decide what you want to know exactly. Is the accuracy of the diagnosis itself your primary concern? Do you need more information about your treatment options and their risks and benefits? Is there a specific drug or treatment you’d like to know more about? Write out all your questions.
Choosing a Provider
Online second opinion services range from those backed by world-class health-care systems (such as Cleveland Clinic, and Massachusetts General Hospital)…to for-profit services (such as Medigo.com and SecondOpinions.com)…to less-than-reputable services. However, there’s no objective quality rating system.
The backing of a name-brand institution doesn’t always guarantee a careful, thorough approach. And a commercial service that recruits experts from a range of good hospitals can sometimes be a better choice. Online second opinions are available for most conditions, including cardiology, cancer, orthopedics and neurology.
Questions to ask…
• How does your service handle the second opinion process? Online second opinion services should use medical records, CT scans, MRI images and lab results to reevaluate your medical condition. They can’t conduct their own physical examinations and may need to order additional tests.
• Who will my doctors be? No matter which service you choose, you should be able to learn the names and confirm the credentials of the doctors who will be reviewing your case.
• How does communication occur? You should look for a service that allows you, whenever possible, to converse directly, by phone or Skype (or something similar), with the physician who reviews your case and have the opportunity to ask questions. You have a right to understand exactly what’s being recommended and why. And never use a provider that simply issues a written report without the opportunity for follow-up questions and further explanations.
• How much will it cost? Health insurers generally do not pay for online second opinions, and they are not covered by Medicare. A reputable online service will often post typical fees on its website, but you should ask for an estimate of the cost for your case. Prices usually start at about $550, with extra fees for radiology and pathology and/or phone or Skype consultations.
Your Medical Records
Once you decide on a service, you—not your doctor—should be the one to gather your medical records and test results and forward them to the second opinion service. (By law, you are entitled to these, but a small charge may be assessed for copying, etc.)
Although the details of your medical examinations and your doctor’s clinical impressions may well be key parts of your medical record, if possible leave out the diagnosis. Even when taking a fresh look, doctors may frame information within the diagnostic label attached to it, picking out the details that confirm this preconceived notion.
• Conflict of interest. Some online second opinion services work directly with employers or health insurance carriers. Your out-of-pocket costs may be minimal, but you can hardly expect a medical team that works for your insurer to be truly independent.
• Lack of human contact. While Skyping can provide face-to-face communication, it may not feel the same to you as in-person communication.
• Treatment complications. If you decide to follow the approach that the second opinion service recommends, your first doctor may not be happy about the new plan and you’ll have to find a third who is agreeable. If your condition requires prompt attention, this will waste valuable time—online second opinions can take up to two weeks.
Also: If a second opinion contradicts the first diagnosis or treatment plan in a meaningful way, be sure to seek a third opinion.
Is It Worth It?
A recent analysis found that second opinions can result in a significant change in diagnosis, prognosis or treatment—ranging from a new diagnosis for 10% of patients with chronic conditions to a new diagnosis and/or treatment advice for 62% of neurology patients.
Even if you get the same diagnosis and end up with the same treatment, a second opinion can give you more trust in your doctors and more confidence that you’re doing the right thing.