Second Opinion Health Article

Preparation

Before seeking a second opinion, patients should contact their health insurance provider to find out if the service is covered. Some insurance companies may request that a second opinion be sought before major elective surgery, and may reserve the right to designate a physician or surgeon to provide the patient evaluation. As of mid-2003, Medicare Part B covered 80% of costs for surgical second opinions after deductible, and 80% for a third opinion if the first two opinions were contradictory. Other Medicare programs may cover second opinions as well; patients should check with their Medicare carrier for details.

There are several ways to find an appropriate health care professional to provide a second opinion. Patients can:

• Ask friends and family for references.
• Ask their primary care physician or another trusted health care provider for a referral.
• Contact an appropriate specialty medical organization (e.g., American College of Surgeons) for a referral.
• Call their local medical licensing board.
• Check with their insurance provider or Medicare carrier.

When seeking a second surgical opinion, patients should find a surgeon who is board-certified in the appropriate specialty by an organization that is part of the American Board of Medical Specialties (ABMS). For example, surgery of the urinary tract may be performed by a provider who is board certified by the American Board of Urology and/or the American Board of Surgery (ABS), two member organizations of the ABMS. Diplomates of ABMS member boards are surgeons who have passed rigorous written and oral testing on these specialties and have met specific accredited educational and residency requirements. In some cases, surgeons may also be certified in subspecialties within a discipline (for example, a vascular surgeon may be board certified by the vascular surgery board of the ABS). The ABMS provides a verification service for patients to check on the certification status of their provider.

In addition, the surgeon may also be a Fellow of the American College of Surgery (ACS), as indicated by the designation F.A.C.S. after their name. This indicates that he or she has met standards of clinical experience, education, ethical conduct, and professional expertise as prescribed by the ACS.

Once a second health care provider is selected, patients should speak with their primary doctor about providing the appropriate medical history, test results, and other pertinent information to the physician who will give the second opinion. The patient may have to sign an information release form to allow the files to be sent. If x rays, magnetic resonance imaging (MRI), or other radiological testing was performed, the second physician may request to see the original films, rather than the radiologist's report of the results, in order to interpret them objectively. In some cases, the office of the surgeon giving the second opinion can arrange to have these materials transferred with a patient's written approval. Patients should call ahead to ensure that all needed materials arrive at the second provider's office before the appointment, to give that physician adequate time to review them and to avoid potentially costly repeat testing.

Normal results

Second opinions that agree with the first provider's conclusions may help ease the patient's mind and provide a clearer picture of the necessary course of treatment or surgery. However, if a patient still feels uncomfortable with the treatment plan outlined by the first and second physicians, or strongly disagrees with their conclusions, a third opinion from another provider is an option.

In cases in which the second provider disagrees with the first provider on diagnosis and/or treatment, the patient has harder choices to face. Again, a third evaluation may be in order from yet another physician, and some insurance companies may actually require this step in cases of conflicting opinions. If a patient is very comfortable with and confident in their primary care provider, they may wish to revisit them to review the second opinion.

In all cases, a patient should remember that their personal preferences, beliefs, and lifestyle considerations must also be considered in their final decision on surgery or treatment, as they are the ones who will live with the results.

BOOKS

Rose, Eric. Second Opinion: The Columbia Presbyterian Guide to Surgery. New York: St. Martin's Press, 2000.

PERIODICALS

Staradub, V. L., et al. "Changes in Breast Cancer Therapy Because of Pathology Second Opinions." Annals of Surgical Oncology 9, no.10 (December 2002): 982–7.

ORGANIZATIONS

American Board of Medical Specialties (ABMS). 1007 Church St., Suite 404, Evanston, IL 60201. (866) ASK-ABMS. <http://www.abms.org>.

American College of Surgeons (ACS). 63 N. St. Clair Drive, Chicago, IL 60611. (312) 202-5000. E-mail: <postmaster @facs.org>. <http://www.facs.org>.

OTHER

Center for Medicare and Medicaid Services (CMS). Getting a Second Opinion Before Surgery. Publication CMS-02173. Revised April 2002. <http://www.medicare.gov/Publications/Pubs/pdf/02173.pdf>.

Paula Ford-Martin