Skip to main content
Top
Published in: Israel Journal of Health Policy Research 1/2017

Open Access 01-12-2017 | Original research article

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel

Authors: Liora Shmueli, Nadav Davidovitch, Joseph S. Pliskin, Ran D. Balicer, Igal Hekselman, Geva Greenfield

Published in: Israel Journal of Health Policy Research | Issue 1/2017

Login to get access

Abstract

Background

Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO.

Methods

A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one.

Results

Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%).

Conclusions

Clinical uncertainty or dissatisfaction with patient-physician communication were the main reasons for seeking a SO. Policy makers should be aware that many patients choose a physician for a SO based on recommendations made outside the medical system. We recommend creating mechanisms that help patients in the complicated process of seeking a SO, suggest specialists who are suitable for the specific medical problem of the patient, and provide tools to reconcile discrepant opinions.
Appendix
Available only for authorised users
Footnotes
1
The financial reports of the health plans’ supplemental insurance programs include a line item entitled “second opinions”, but it is important to keep in mind that this term is somewhat misleading as the amounts presented include all payments to physicians for ambulatory care services, including first opinions.
 
Literature
1.
go back to reference Althabe F, Belizan JM, Villar J, Alexander S, Bergel E, Ramos S, et al. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial. Lancet. 2004;363:1934–40.CrossRef Althabe F, Belizan JM, Villar J, Alexander S, Bergel E, Ramos S, et al. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial. Lancet. 2004;363:1934–40.CrossRef
2.
go back to reference 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;63:791–5.CrossRef 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;63:791–5.CrossRef
3.
go back to reference 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;13:81–4.CrossRef 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;13:81–4.CrossRef
4.
go back to reference Mellink WA, Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing JM. Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21:1492–7.CrossRef Mellink WA, Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing JM. Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21:1492–7.CrossRef
5.
go back to reference Wieske L, Wijers D, Richard E, Vergouwen MDI, Stam J. Second opinions and tertiary referrals in neurology: a prospective observational study. J Neurol. 2008;255:1743–9.CrossRef Wieske L, Wijers D, Richard E, Vergouwen MDI, Stam J. Second opinions and tertiary referrals in neurology: a prospective observational study. J Neurol. 2008;255:1743–9.CrossRef
6.
go back to reference Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255:135–41.CrossRef Zan E, Yousem DM, Carone M, Lewin JS. Second-opinion consultations in neuroradiology. Radiology. 2010;255:135–41.CrossRef
7.
go back to reference Rosenberg SN, Allen DR, Handte JS, Jackson TC, Leto L, Rodstein BM, et al. Effect of utilization review in a fee-for-service health insurance plan. N Engl J Med. 1995;333:1326–30.CrossRef Rosenberg SN, Allen DR, Handte JS, Jackson TC, Leto L, Rodstein BM, et al. Effect of utilization review in a fee-for-service health insurance plan. N Engl J Med. 1995;333:1326–30.CrossRef
8.
go back to reference Ruchlin HS, Finkel ML, McCarthy EG. The efficacy of second-opinion consultation programs: a cost-benefit perspective. Med Care. 1982;20:3–20.CrossRef Ruchlin HS, Finkel ML, McCarthy EG. The efficacy of second-opinion consultation programs: a cost-benefit perspective. Med Care. 1982;20:3–20.CrossRef
9.
go back to reference McCarthy EG, Finkel ML, Ruchlin HS. Second opinions on elective surgery. The Cornell/New York hospital study. Lancet. 1981;1:1352–4.CrossRef McCarthy EG, Finkel ML, Ruchlin HS. Second opinions on elective surgery. The Cornell/New York hospital study. Lancet. 1981;1:1352–4.CrossRef
10.
go back to reference Tam KF, Cheng DK, Ng TY, Ngan HY. The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients. Support. Care cancer off. J. Multinatl. Assoc. Support Care Cancer. 2005;13:679–84.CrossRef Tam KF, Cheng DK, Ng TY, Ngan HY. The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients. Support. Care cancer off. J. Multinatl. Assoc. Support Care Cancer. 2005;13:679–84.CrossRef
11.
go back to reference Wagner T, Wagner L. Who gets second opinions? Health Aff Proj Hope. 1999;18:137–45.CrossRef Wagner T, Wagner L. Who gets second opinions? Health Aff Proj Hope. 1999;18:137–45.CrossRef
13.
go back to reference Ridic G, Gleason S, Ridic O. Comparisons of health Care Systems in the United States, Germany and Canada. Mater. Socio-Medica. 2012;24:112.CrossRef Ridic G, Gleason S, Ridic O. Comparisons of health Care Systems in the United States, Germany and Canada. Mater. Socio-Medica. 2012;24:112.CrossRef
15.
go back to reference Lysack JT, Hoy M, Hudon ME, Nakoneshny SC, Chandarana SP, Matthews TW, et al. Impact of neuroradiologist second opinion on staging and management of head and neck cancer. J. Otolaryngol. Head Neck Surg. 2013;42:39. Lysack JT, Hoy M, Hudon ME, Nakoneshny SC, Chandarana SP, Matthews TW, et al. Impact of neuroradiologist second opinion on staging and management of head and neck cancer. J. Otolaryngol. Head Neck Surg. 2013;42:39.
16.
go back to reference Rutkow IM. Surgical decision making. The reproducibility of clinical judgement. Arch. Surg. Chic. Ill 1960. 1982;117:337–40. Rutkow IM. Surgical decision making. The reproducibility of clinical judgement. Arch. Surg. Chic. Ill 1960. 1982;117:337–40.
17.
go back to reference Grafe WR, McSherry CK, Finkel ML, McCarthy EG. The elective surgery second opinion program. Ann Surg. 1978;188:323–30.CrossRef Grafe WR, McSherry CK, Finkel ML, McCarthy EG. The elective surgery second opinion program. Ann Surg. 1978;188:323–30.CrossRef
18.
go back to reference McCarthy EG, Finkel ML. Second consultant opinion for elective orthopedic surgery. Am J Public Health. 1981;71:1233–6.CrossRef McCarthy EG, Finkel ML. Second consultant opinion for elective orthopedic surgery. Am J Public Health. 1981;71:1233–6.CrossRef
20.
go back to reference Chang H-R, Yang M-C, Chung K-P. Can cancer patients seeking a second opinion get better care? Am J Manag Care. 2013;19:380–7.PubMed Chang H-R, Yang M-C, Chung K-P. Can cancer patients seeking a second opinion get better care? Am J Manag Care. 2013;19:380–7.PubMed
21.
go back to reference Martin SG, Shwartz M, Whalen BJ, D’Arpa D, Ljung GM, Thorne JH, et al. Impact of a mandatory second-opinion program on medicaid surgery rates. Med Care. 1982;20:21–45.CrossRef Martin SG, Shwartz M, Whalen BJ, D’Arpa D, Ljung GM, Thorne JH, et al. Impact of a mandatory second-opinion program on medicaid surgery rates. Med Care. 1982;20:21–45.CrossRef
22.
go back to reference 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;302:1169–74.CrossRef 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;302:1169–74.CrossRef
23.
go back to reference Graboys TB, Headley A, Lown B, Lampert S, Blatt CM. Results of a second-opinion program for coronary artery bypass graft surgery. JAMA. J Am Med Assoc. 1987;258:1611–4.CrossRef Graboys TB, Headley A, Lown B, Lampert S, Blatt CM. Results of a second-opinion program for coronary artery bypass graft surgery. JAMA. J Am Med Assoc. 1987;258:1611–4.CrossRef
24.
go back to reference Greenfield G, Pliskin JS, Wientroub S, Davidovitch N. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study. Isr. J. Health Policy Res. 2012;1:30.CrossRef Greenfield G, Pliskin JS, Wientroub S, Davidovitch N. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study. Isr. J. Health Policy Res. 2012;1:30.CrossRef
27.
go back to reference Filc D, Davidovitch N. Rethinking the private–public mix in health care: analysis of health reforms in Israel during the last three decades. J. Health Serv. Res. Policy. 2016;21:249–56.CrossRef Filc D, Davidovitch N. Rethinking the private–public mix in health care: analysis of health reforms in Israel during the last three decades. J. Health Serv. Res. Policy. 2016;21:249–56.CrossRef
28.
go back to reference Vashitz G, Davidovitch N, Pliskin JS. Second medical opinions. Harefuah. 2011;150:105–10. 207PubMed Vashitz G, Davidovitch N, Pliskin JS. Second medical opinions. Harefuah. 2011;150:105–10. 207PubMed
29.
go back to reference Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, et al. Second medical opinion: utilization rates and characteristics of seekers in a general population. Med Care. 2016;1 Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, et al. Second medical opinion: utilization rates and characteristics of seekers in a general population. Med Care. 2016;1
30.
go back to reference Sato T, Takeichi M, Hara T, Koizumi S. Second opinion behaviour among Japanese primary care patients. Br. J. Gen. PractJ R Coll Gen Pract. 1999;49:546–50. Sato T, Takeichi M, Hara T, Koizumi S. Second opinion behaviour among Japanese primary care patients. Br. J. Gen. PractJ R Coll Gen Pract. 1999;49:546–50.
31.
go back to reference Sapir R, Catane R, Kaufman B, Isacson R, Segal A, Wein S, et al. Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service. Support Care Cancer. 2000;8:458–63.CrossRef Sapir R, Catane R, Kaufman B, Isacson R, Segal A, Wein S, et al. Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service. Support Care Cancer. 2000;8:458–63.CrossRef
32.
go back to reference Tattersall MHN, Dear RF, Jansen J, Shepherd HL, Devine RJ, Horvath LG, et al. Second opinions in oncology: the experiences of patients attending the Sydney cancer Centre. Med J Aust. 2009;191:209–12.PubMed Tattersall MHN, Dear RF, Jansen J, Shepherd HL, Devine RJ, Horvath LG, et al. Second opinions in oncology: the experiences of patients attending the Sydney cancer Centre. Med J Aust. 2009;191:209–12.PubMed
34.
go back to reference Oskay-Ozcelik G, Lehmacher W, Konsgen D, Christ H, Kaufmann M, Lichtenegger W, 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;18:479–84.CrossRef Oskay-Ozcelik G, Lehmacher W, Konsgen D, Christ H, Kaufmann M, Lichtenegger W, 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;18:479–84.CrossRef
35.
go back to reference Payne VL, Singh H, Meyer AND, Levy L, Harrison D, Graber ML. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc. 2014;89:687–96.CrossRef Payne VL, Singh H, Meyer AND, Levy L, Harrison D, Graber ML. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc. 2014;89:687–96.CrossRef
36.
go back to reference Saltman RB. Viewing second opinions in terms of recent developments in patient choice. Isr J Health Policy Res. 2012;1:31.CrossRef Saltman RB. Viewing second opinions in terms of recent developments in patient choice. Isr J Health Policy Res. 2012;1:31.CrossRef
37.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.CrossRef
38.
go back to reference Abramson JH. Research methods in community medicine: surveys, epidemiological research, programme evaluation, clinical trials. 6th ed. Chichester, England. Hoboken, NJ: Wiley; 2008.CrossRef Abramson JH. Research methods in community medicine: surveys, epidemiological research, programme evaluation, clinical trials. 6th ed. Chichester, England. Hoboken, NJ: Wiley; 2008.CrossRef
39.
go back to reference Clauson J, Hsieh YC, Acharya S, Rademaker AW, Morrow M. Results of the Lynn sage second-opinion program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered. Cancer. 2002;94:889–94.CrossRef Clauson J, Hsieh YC, Acharya S, Rademaker AW, Morrow M. Results of the Lynn sage second-opinion program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered. Cancer. 2002;94:889–94.CrossRef
40.
go back to reference 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;76:44–50.CrossRef 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;76:44–50.CrossRef
41.
go back to reference Greenfield G, Pliskin JS, Feder-Bubis P, Wientroub S, Davidovitch N. Patient-physician relationships in second opinion encounters - the physicians’ perspective. Soc Sci Med. 2012;75:1202–12.CrossRef Greenfield G, Pliskin JS, Feder-Bubis P, Wientroub S, Davidovitch N. Patient-physician relationships in second opinion encounters - the physicians’ perspective. Soc Sci Med. 2012;75:1202–12.CrossRef
42.
go back to reference Moumjid N, Gafni A, Bremond A, Carrere MO. Seeking a second opinion: do patients need a second opinion when practice guidelines exist? Health Policy Amst Neth. 2007;80:43–50.CrossRef Moumjid N, Gafni A, Bremond A, Carrere MO. Seeking a second opinion: do patients need a second opinion when practice guidelines exist? Health Policy Amst Neth. 2007;80:43–50.CrossRef
43.
go back to reference Philip J, Gold M, Schwarz M, Komesaroff P. Second medical opinions: the views of oncology patients and their physicians. Support Care Cancer. 2010;18:1199–205.CrossRef Philip J, Gold M, Schwarz M, Komesaroff P. Second medical opinions: the views of oncology patients and their physicians. Support Care Cancer. 2010;18:1199–205.CrossRef
44.
go back to reference 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;6:195–201.CrossRef 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;6:195–201.CrossRef
45.
go back to reference Sutherland LR, Verhoef MJ. Patients who seek a second opinion: are they different from the typical referral? J Clin Gastroenterol. 1989;11:308–13.CrossRef Sutherland LR, Verhoef MJ. Patients who seek a second opinion: are they different from the typical referral? J Clin Gastroenterol. 1989;11:308–13.CrossRef
46.
go back to reference Bayliss R. Second opinions. Br. Med. J. Clin Res. 1988;296:808–9. Bayliss R. Second opinions. Br. Med. J. Clin Res. 1988;296:808–9.
48.
go back to reference Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst. 1999;91:1480–6.CrossRef Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst. 1999;91:1480–6.CrossRef
49.
go back to reference Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. J Am Med Assoc. 2009;302:1551–6.CrossRef Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA. J Am Med Assoc. 2009;302:1551–6.CrossRef
50.
go back to reference Hanna N, Shoenbachler DD, Gordon GL. Physician choice criteria. Health Mark Q. 1995;12:29–42.CrossRef Hanna N, Shoenbachler DD, Gordon GL. Physician choice criteria. Health Mark Q. 1995;12:29–42.CrossRef
51.
go back to reference Dobele A, Lindgreen A. Exploring the nature of value in the word-of-mouth referral equation for health care. J Mark Manag. 2011;27:269–90.CrossRef Dobele A, Lindgreen A. Exploring the nature of value in the word-of-mouth referral equation for health care. J Mark Manag. 2011;27:269–90.CrossRef
52.
go back to reference Yahanda AT, Lafaro KJ, Spolverato G, Pawlik TMA. Systematic review of the factors that patients use to choose their surgeon. World J Surg. 2016;40:45–55.CrossRef Yahanda AT, Lafaro KJ, Spolverato G, Pawlik TMA. Systematic review of the factors that patients use to choose their surgeon. World J Surg. 2016;40:45–55.CrossRef
53.
go back to reference Hennig-Thurau T, Gwinner KP, Walsh G, Gremler DD. Electronic word-of-mouth via consumer-opinion platforms: what motivates consumers to articulate themselves on the internet? J Interact Mark. 2004;18:38–52.CrossRef Hennig-Thurau T, Gwinner KP, Walsh G, Gremler DD. Electronic word-of-mouth via consumer-opinion platforms: what motivates consumers to articulate themselves on the internet? J Interact Mark. 2004;18:38–52.CrossRef
55.
go back to reference Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients’ use of the internet for medical information. J Gen Intern Med. 2002;17:180–5.CrossRef Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients’ use of the internet for medical information. J Gen Intern Med. 2002;17:180–5.CrossRef
56.
go back to reference Keshet Y, Liberman I. Coping with illness and threat: why non-religious Jews choose to consult rabbis on healthcare issues. J Relig Health. 2014;53:1146–60.CrossRef Keshet Y, Liberman I. Coping with illness and threat: why non-religious Jews choose to consult rabbis on healthcare issues. J Relig Health. 2014;53:1146–60.CrossRef
Metadata
Title
Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel
Authors
Liora Shmueli
Nadav Davidovitch
Joseph S. Pliskin
Ran D. Balicer
Igal Hekselman
Geva Greenfield
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Israel Journal of Health Policy Research / Issue 1/2017
Electronic ISSN: 2045-4015
DOI
https://doi.org/10.1186/s13584-017-0191-y

Other articles of this Issue 1/2017

Israel Journal of Health Policy Research 1/2017 Go to the issue