Clinical Corner: The Value of Second Opinions

By Raffi Terzian, M.D.
Senior Medical Director and
Senior Vice President of Clinical Operations
Health Advocate

Obtaining a second opinion can help patients make better informed decisions about their care. While some patients may be uneasy, providers should reassure their patients that it is acceptable to pursue a second opinion if they elect to do so. The American Medical Association Code of Medical Ethics provides guidance to providers regarding consultation, referral and second opinions and asserts that “Physicians’ fiduciary obligation to promote patients’ best interests and welfare can include consulting other physicians for advice.”

In some cases, second opinions can shed light on diagnostic uncertainty. Researchers from the Mayo Clinic published a study in April 2017 which explored the impact of second opinions on changes in diagnosis. They found that final diagnoses were better defined or refined in sixty-six percent of cases. Furthermore, the researchers found that in twenty-one percent of cases, final diagnoses were different from the initial diagnosis. Clarifying diagnostic uncertainty can also lead to more cost-effective care.

The value of second opinions can be viewed through the broader context of care coordination and making sure that patients are accessing the appropriate care in a timely and efficient manner. If a patient decides to pursue a second opinion, it is helpful to be prepared in advance with questions to ask the provider. Second opinions may be sought as in-person consultations or remotely/online by submitting medical records for review by an expert in a given field. The in-person consultation is typically covered by most health insurance plans, though it’s a good idea to confirm benefit coverage in advance. Medicare Part B also allows coverage of second opinions in some circumstances. Centers that provide remote or chart review second opinions will charge for the consultation as well as any medical record collection that may be required. These types of consultations are typically not covered by insurance.

Overall, second opinions can be valuable in bringing clarity to patients facing a diagnostic dilemma, or to those seeking confidence in a proposed treatment plan, further empowering them to take an active role in their ongoing care.


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