Do You Need a Third Opinion?
Sometimes you need more experts to break a tie.
When you, or someone you love, faces a serious or life-threatening medical condition, a medical second opinion can guide crucial treatment decisions you and your doctor make. But what happens when your first and second opinions clash?
What you need to know
It happens all too often. The numbers are surprising – and reveal how conflicting opinions could affect your diagnosis, your treatment and your future:
- Treatment changes. In a recent, nationwide review of 6,791 first and second opinions, published in The American Journal of Medicine, researchers from the Houston Veterans Affairs Center and Baylor College of Medicine found that treatments differed 86% of the time between initial and second evaluations. Some differences were minor. But for 30% of the women and men in the study, the “clinical impact” was moderate to major – with the highest numbers for those facing colorectal surgery, thoracic surgery, cancer and blood disorders.
- Diagnosis shifts. When Mayo Clinic researchers reviewed the records of 286 people who came to the Rochester, MN medical center for a second opinion over two years, 21% got a completely new diagnosis, according to a 2017 study in the Journal of Evaluation in Clinical Practice. The phenomenon behind it is called “diagnostic uncertainty” — and raises the risk for delayed care, medical errors and even death, especially in areas of medicine where in-house checks and reviews are not common. “Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling,” one of the researchers remarked to reporters.
What you should do
If you’ve received conflicting medical opinions, your next steps are important ones. One route recommended by major medical organizations in this situation: Do your own research. Groups like the American Cancer Society suggest consulting with both doctors, asking them to consult with each other, finding out how they reached their decisions – including how medical studies, treatment guidelines and their own clinical experience factor into their views – and learning more on your own about the condition and about clinical trials that could offer treatment alternatives.
Get a third opinion
Those are smart steps, but the process can be time-consuming and stressful. There’s another route: Getting a third opinion.
Surprised? The practice is well-established in the medical community. Among the organizations that have come out in support of the usefulness of a third medical opinion are the U.S. government, the patient-empowerment group Center for Advancing Healthcare, the American Cancer Society, the American Heart Association, the Leukemia & Lymphoma Society, and major medical centers from coast to coast.
Where to turn?
Emerging research shows that the most accurate re-checks of diagnosis and treatment plans come from multi-disciplinary teams of highly-trained and experienced specialists. One example from the medical literature: When specialists in adult or pediatric neuro-oncology or head and neck surgery reviewed 55 brain-cancer studies with conflicting first and second opinions, they found that second opinions from oncologic neuro-radiologists at a National Cancer Institute-designated cancer center were accurate 100% of the time in a 2016 study from New York City’s Memorial Sloan Kettering Cancer Center. Consulting the right specialists leads to better care and fewer medical errors, the researchers note. And in two case reports from VU University Medical Center in The Netherlands, reviews of lung-cancer cases by multi-disciplinary teams trained to evaluate PET and CT scans, biopsies and blood tests changed the course of treatment radically — and for the better.
Call for teamwork
How can you identify the right specialists and better yet, assemble a team? One option: Turning to an experienced, established medical second opinion service provider who gathers information from you and your doctor, then arranges an evaluation with a multi-disciplinary team of specialists highly-trained in the diagnosis and treatment of your specific condition. WorldCare International, Inc. has been providing this access to world-class specialists for more than 25 years.
“When our doctors have a different opinion than your doctor, we don’t leave it at that,” says Richard Heinzl, MD, MPH, Global Medical Director at WorldCare. “We do a tie-breaker opinion — a third independent opinion — at a separate institution. Almost always the third agrees with our second opinion. Then we go back to the referring physician and explain what we believe is the correct diagnosis.”
Patients, of course, find this comforting. “It was a great relief to finally receive a coordinated medical opinion regarding my diagnosis,” notes one WorldCare member. “I had received a few differing opinions regarding the treatment options, which were confusing as they were presented by individual specialists and not as a consultative group such as WorldCare. The booklet is a tremendous tool to bring to any future consultations as well as an invaluable personal medical record.”