Evaluation of Outcomes From a National Patient-initiated Second-opinion Program

Ashley N.D. Meyer, Hardeep Singh, Mark L. Graber

To examine outcomes of patient-initiated second opinions provided by a national second-opinion program. We independently examined data collected from January 1, 2011-December 31, 2012 from a second-opinion program (Best Doctors, Inc.) that allows employee-beneficiaries to request free second opinions. Clinical intake included ascertaining why patients sought second opinions and acquiring patients' complete medical records. Trained physicians summarized the cases; identified key, unresolved clinical questions; and forwarded the cases to expert specialists who provided independent assessments and recommendations. Second opinions were discussed with and returned to patients for review with their physicians. Nurses determined whether second opinions confirmed, clarified, or changed initial diagnoses and treatments and physicians estimated their clinical impact. Patient satisfaction was also surveyed. 6,791 patient-initiated second opinions were completed across medical specialties. Patients primarily sought second opinions for help choosing treatment options (41.3%) and for diagnostic concerns (34.8%). Second opinions often resulted in changes in diagnosis (14.8%), treatment (37.4%), changes in either diagnosis or treatment (41.5%) and changes in both (10.6%). Clinical impact was estimated as moderate/major in 20.9% of cases for diagnosis and 30.7% of cases for treatment. Changes in diagnoses and/or treatments and clinical impact varied across medical specialties. In patients surveyed (n=2,683), most (94.7%) were satisfied with the experience, but fewer (61.2%) planned to follow the recommendations. Patient-initiated second opinions led to recommended changes in diagnosis or treatment for over 40% of participants. Further evaluation is needed to determine whether this impacts clinical outcomes, such as the reduction of diagnosis and treatment errors.