Knowing he needed help figuring out his next steps, he reached out to a health care advocate for help.
One week later, he was seen by another neurosurgeon who reviewed his MRI films and said, "Let's watch this and check another MRI in six months."
Six months later, after reviewing a second MRI, the neurosurgeon declared the tumor gone explaining it away as likely "just inflammation." The patient's facial drooping subsided and he retired without having surgery.
Not only did that second opinion save him from brain surgery and a long rehabilitation, it also saved his employer thousands of dollars in insurance claims.
A second opinion is a critical part of ensuring a patient's informed consent and decision-making. From a cost-effectiveness point of view, second opinions can save health insurance providers money by establishing the certainty of a clinical need (or lack of need) for surgery, particularly when a diagnosis is life-threatening.
One study published in the "Annals of Surgical Oncology," found that getting a second opinion on pathology slides of breast cancers changed the initial diagnosis, prognosis or treatment approach in 80% of the 340 study subjects.
So, if seeking a second opinion typically yields positive results, why do so few patients pursue one?
In the midst of a health care crisis, even the savviest health care consumer can find the task of identifying another physician daunting. It can be overwhelming to navigate where to go, decide which doctor to see and figure out how to get appropriate medical records to the selected office.
Patients need help. As potential resources for employees, you can provide guidance.
First-hand tips for second opinions
To make the effort worthwhile, patients should consider seeing physicians who treat a lot of patients with the same diagnosis. Consider academic medical centers, as these facilities usually have many physicians on staff and there may be one or two who have specialized in a particular diagnosis.
Also, since such facilities generally also conduct research, physicians may be able to offer or provide access to advanced treatments and clinical trials. Patients may also consider asking their primary care physician for a referral, or investigating Web sites of appropriate specialty medical organizations to confirm the physician's certification.
Once a physician has been identified here are some other tips:
1. Investigate the insurance coverage.
While patients have a legal right to a second opinion, insurers can interpret that right differently, some giving carte blanche to consult anyone but reimbursing at a lower rate and some, mainly HMOs, restricting your choices to their network. Understanding any particular processes for getting a second opinion, such as a requirement to obtain prior authorization, always is a important
2. Make sure all medical records are sent to the second provider.
If X-rays, MRIs or CT scans were used in the original diagnosis, it may be helpful to obtain the original films rather than just the radiologist's reports. The physician can then interpret them objectively.
3. Call ahead to make sure that all materials arrived at the second provider's office.
This step is most important, as it will prevent potentially costly repeat testing and make better use of the patient's time with the physician in discussing their treatment recommendations
4. Prepare a list of questions.
One of the most crucial questions to ask is, "For this diagnosis, what are all of my options?"
5. Take another person to the visit.
Participating in the appointment as a patient requires focus, which may be lacking if the patient is scared or nervous. Taking a friend, relative or other loved one to the appointment can provide an objective ear and that person can take notes on what the physician says.
Dealing with the health care system can be grueling, but despite the effort required, getting a second opinion could be a life-saving and cost-saving step. If an employee comes to you for help, take the time to offer your support and practical advice.
Contributing Editor Betty Long is a registered nurse and founder of Guardian Nurses Healthcare Advocates, a health care advocacy firm that has helped thousands of patients navigate the health care system and saved millions of dollars in health care costs.
