Skip to main content

Advertisement

Log in

Do First Opinions Affect Second Opinions?

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians.

Objective

To evaluate whether physicians’ judgment is affected by another medical opinion given to a patient.

Design

Orthopedic surgeons and neurologists filled out questionnaires presenting eight hypothetical clinical scenarios with suggested treatments. One group of physicians (in each specialty) was told what the other physician’s opinion was (study group), and the other group was not told what it was (control group).

Participants

A convenience sample of 332 physicians in Israel: 172 orthopedic surgeons (45.9% of their population) and 160 neurologists (64.0% of their population).

Measurements

Scoring was by choice of less or more interventional treatment in the scenarios. We used χ2 tests and repeated measures ANOVA to compare these scores between the two groups. We also fitted a cumulative ordinal regression to account for the dependence within each physician’s responses.

Results

Orthopedic surgeons in the study group chose a more interventionist treatment when the other physician suggested an intervention than those in the control group [F (1, 170) = 4.6, p = 0.03; OR = 1.437, 95% CI 1.115-1.852]. Evaluating this effect separately in each scenario showed that in four out of the eight scenarios, they chose a more interventional treatment when the other physician suggested an intervention (scenario 1, p = 0.039; scenario 2, p < 0.001; scenario 3, p = 0.033; scenario 6, p < 0.001). These effects were insignificant among the neurologists [F (1,158) = 0.44, p = 0.51; OR = 1.087, 95% CI 0.811-1.458]. In both specialties there were no differences in responses by level of clinical experience [orthopedic surgeons: F (2, 166) = 0.752, p = 0.473; neurologists: F (2,154) = 1.951, p = 0.146].

Conclusions

The exploratory survey showed that in some cases physicians’ judgments may be affected by other physicians’ opinions, but unaffected in other cases. Weighing previous opinions may yield a more informed clinical decision, yet physicians may be unintentionally influenced by previous opinions. Second opinion has the potential to improve the clinical decision-making processes, and mechanisms are needed to reconcile discrepant opinions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

References

  1. Gertman PM, Stackpole DA, Levenson DK, Manuel BM, Brennan RJ, Janko GM. Second opinions for elective surgery. The mandatory Medicaid program in Massachusetts. N Engl J Med. 1980;302(21):1169–74.

    Article  PubMed  CAS  Google Scholar 

  2. Althabe F, Belizan JM, Villar J, et al. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomized controlled trial. Lancet. 2004;363(9425):1934–40.

    Article  PubMed  Google Scholar 

  3. Graboys TB, Biegelsen B, Lampert S, Blatt CM, Lown B. Results of a second-opinion trial among patients recommended for coronary angiography. JAMA. 1992;268(18):2537–40.

    Article  PubMed  CAS  Google Scholar 

  4. Han KS, Joung JY, Cho KS, et al. Results of repeated transurethral resection for a second opinion in patients referred for nonmuscle invasive bladder cancer: The referral cancer center experience and review of the literature. J Endourol. 2008;22(12):2699–704.

    Article  PubMed  Google Scholar 

  5. Kronz JD, Westra WH. The role of second opinion pathology in the management of lesions of the head and neck. Curr Opin Otolaryngol Head Neck Surg. 2005;13(2):81–4.

    Article  PubMed  Google Scholar 

  6. Briggs GM, Flynn PA, Worthington M, Rennie I, McKinstry CS. The role of specialist neuroradiology second opinion reporting: Is there added value? Clin Radiol. 2008;63(7):791–5.

    Article  PubMed  CAS  Google Scholar 

  7. Tomaszewski JE, Bear HD, Connally JA, et al. Consensus conference on second opinions in diagnostic anatomic pathology. Who, what, and when. Am J Clin Pathol. 2000;114(3):329–35.

    PubMed  CAS  Google Scholar 

  8. McSherry CK, Chen PJ, Worner TM, Kupferstein N, McCarthy EG. Second surgical opinion programs: Dead or alive? J Am Coll Surg. 1997;185(5):451–6.

    PubMed  CAS  Google Scholar 

  9. Vierhout WP, Knottnerus JA, van Ooij A, et al. Effectiveness of joint consultation sessions of general practitioners and orthopedic surgeons for locomotor-system disorders. Lancet. 1995;346(8981):990–4.

    Article  PubMed  CAS  Google Scholar 

  10. Graboys TB, Headley A, Lown B, Lampert S, Blatt CM. Results of a second-opinion program for coronary artery bypass graft surgery. JAMA. 1987;258(12):1611–4.

    Article  PubMed  CAS  Google Scholar 

  11. Meyer JE, Eberlein TJ, Stomper PC, Sonnenfeld MR. Biopsy of occult breast lesions. analysis of 1261abnormalities. JAMA. 1990;263(17):2341–3.

    Article  PubMed  CAS  Google Scholar 

  12. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):1551–6.

    Article  PubMed  CAS  Google Scholar 

  13. Rosenberg SN, Allen DR, Handte JS, et al. Effect of utilization review in a fee-for-service health insurance plan. N Engl J Med. 1995;333(20):1326–30.

    Article  PubMed  CAS  Google Scholar 

  14. Myers SA, Gleicher N. A successful program to lower cesarean-section rates. N Engl J Med. 1988;319(23):1511–6.

    Article  PubMed  CAS  Google Scholar 

  15. Wagner TH, Wagner LS. Who gets second opinions? Health Aff (Millwood). 1999;18(5):137–45.

    Article  CAS  Google Scholar 

  16. 1997 public opinion of patient safety issues. Available at: www.npsf.org/wp-content/uploads/2011/10/Public_Opinion_of_Patient_Safety_Issues.pdf. Accessed March 15, 2012.

  17. Coblentz TR, Mills SE, Theodorescu D. Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Cancer. 2001;91(7):1284–90.

    Article  PubMed  CAS  Google Scholar 

  18. Epstein JI, Walsh PC, Sanfilippo F. Clinical and cost impact of second-opinion pathology. Review of prostate biopsies prior to radical prostatectomy. Am J Surg Pathol. 1996;20(7):851–7.

    Article  PubMed  CAS  Google Scholar 

  19. McCarthy EG, Finkel ML, Ruchlin HS. Second opinions on elective surgery. The Cornell/New York Hospital Study. Lancet. 1981;1(8234):1352–4.

    Article  PubMed  CAS  Google Scholar 

  20. Thompson JN, Varley CK, McClellan J, et al. Second opinions improve ADHD prescribing in a Medicaid-insured community population. J Am Acad Child Adolesc Psychiatry. 2009;48(7):740–8.

    Article  PubMed  Google Scholar 

  21. Moumjid N, Gafni A, Bremond A, Carrere MO. Seeking a second opinion: Do patients need a second opinion when practice guidelines exist? Health Policy. 2007;80(1):43–50.

    Article  PubMed  Google Scholar 

  22. Axon A, Hassan M, Niv Y, Beglinger C, Rokkas T. Ethical and legal implications in seeking and providing a second medical opinion. Dig Dis. 2008;26(1):11–7.

    Article  PubMed  Google Scholar 

  23. Sutherland LR, Verhoef MJ. Patients who seek a second opinion: Are they different from the typical referral? J Clin Gastroenterol. 1989;11(3):308–13.

    Article  PubMed  CAS  Google Scholar 

  24. Elder NC, Jacobson CJ, Zink T, Hasse L. How experiencing preventable medical problems changed patients' interactions with primary health care. Ann Fam Med. 2005;3(6):537–44.

    Article  PubMed  Google Scholar 

  25. Goldman RE, Sullivan A, Back AL, Alexander SC, Matsuyama RK, Lee SJ. Patients' reflections on communication in the second-opinion hematology-oncology consultation. Patient Educ Couns. 2009;76(1):44–50.

    Article  PubMed  Google Scholar 

  26. Oskay-Ozcelik G, Lehmacher W, Konsgen D, et al. Breast cancer patients' expectations in respect of the physician-patient relationship and treatment management results of a survey of 617 patients. Ann Oncol. 2007;18(3):479–84.

    Article  PubMed  CAS  Google Scholar 

  27. Sato T, Takeichi M, Hara T, Koizumi S. Second opinion behavior among Japanese primary care patients. Br J Gen Pract. 1999;49(444):546–50.

    PubMed  CAS  Google Scholar 

  28. van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy. 2001;6(4):195–201.

    Article  PubMed  Google Scholar 

  29. Philip J, Gold M, Schwarz M, Komesaroff P. An exploration of the dynamics and influences upon second medical opinion consultations in cancer care. Asia-Pacific Journal of Clinical Oncology. 2011;7(1):41–6.

    Article  PubMed  Google Scholar 

  30. McCulloch CE, Searle SR. Generalized, linear, and mixed models. New York: J. Wiley; 2001:208–12.

    Google Scholar 

  31. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.

    Google Scholar 

  32. Rutkow IM, Gittelsohn AM, Zuidema GD. Surgical decision making. the reliability of clinical judgment. Ann Surg. 1979;190(3):409–19.

    Article  PubMed  CAS  Google Scholar 

  33. Leape LL. Unnecessary surgery. Health Serv Res. 1989;24(3):351–407.

    PubMed  CAS  Google Scholar 

  34. McCarthy EG, Finkel ML. Second consultant opinion for elective orthopedic surgery. Am J Public Health. 1981;71(11):1233–6.

    Article  PubMed  CAS  Google Scholar 

  35. Danzon P. The frequency and severity of medical malpractice claims. J Law Econ. 1984;27(1):115–48.

    Article  PubMed  CAS  Google Scholar 

  36. Neale G. Reducing risks in gastroenterological practice. Gut. 1998;42(1):139–42.

    Article  PubMed  CAS  Google Scholar 

  37. Asch D, Jedrziewski M, Christakis N. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50(10):1129–36.

    Article  PubMed  CAS  Google Scholar 

  38. Cummings S, Savitz L, Konrad T. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35(6):1347–55.

    PubMed  CAS  Google Scholar 

  39. Jepson C, Asch D, Hershey J, Ubel P. In a mailed physician survey, questionnaire length had a threshold effect on response rate. J Clin Epidemiol. 2005;58(1):103–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the physicians who participated in the survey. We would like to thank David Shinar, PhD, for his help with the study concept and design. We thank Alex Aviram, MD, and Roni Gamzo, MD, PhD, for their comprehensive review of an earlier draft, and Simone Moran, PhD, Ran Balicer, MD, PhD, and Joachim Meyer, PhD, for helpful insights. Additionally, we thank Mrs. Esther Eshkol for editorial assistance.

Financial support

Funding was provided by a grant from the Israel National Institute for Health Policy and Health Service Research (NIHP R/07/94).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geva Vashitz PhD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 134 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vashitz, G., Pliskin, J.S., Parmet, Y. et al. Do First Opinions Affect Second Opinions?. J GEN INTERN MED 27, 1265–1271 (2012). https://doi.org/10.1007/s11606-012-2056-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-012-2056-y

KEY WORDS

Navigation