Second Opinions Are Good Medicine for ‘Overtreatment’

The epidemic of overtreatment in U.S. health care is figuring ever more prominently into public policy and private care. We’ve repeatedly discussed how this country medically defaults toward testing, screening, prescribing and treating. We’ve shown how such “over care” isn’t the best practice, nor does it necessarily extend lives or reduce suffering.

A recent post on perfectly illustrates this point, and makes another abundantly clear: the value of second opinions. Although some practitioners, patients and insurers question the wisdom of getting a second opinion, for serious or complicated diagnoses and procedures, clearly they save time, money and, sometimes, lives.

Writer Rosemary Gibson, author of “The Treatment Trap” and “Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans,” recounts an interview with a former employee benefits executive for a Fortune 100 company. Although his company’s routine second-opinion policy seems expensive and protracted, here are some of the benefits it reaped:

  • cases in which transplants were recommended for people who were going to die soon from cancer whether the transplant was done or not;
  • a hospital recommended a heart-lung transplant, but when the patient visited the Mayo Clinic (at the company’s expense) for a second opinion, it was discovered that neither transplant surgery was indicated;
  • an employee was told he needed a heart transplant, and the surgeon said the patient shouldn’t fly anywhere for a second opinion in his condition. But the employee had flown to see that surgeon. He flew, at company expense, to Mayo, where the second opinion was a small blockage. It was treated successfully with a stent.

Four in 10 of the organ transplants that had been recommended for employees were found not to be medically necessary or appropriate after the company flew them to the Mayo Clinic.

These patients were spared extensive, invasive, prolonged treatment. The company maximized its human resources and everyone saved money.

As Gibson writes, “So far, the work to shine a light on overtreatment is compelling.” She refers interested parties-patients, their caregivers, practitioners and insurers-to the “Top Five” good practices in several medical specialties developed by the National Physicians Alliance.

Wise choices are integral, she says, to medical professionalism. “We need to get to the high hanging fruit where real and immediate harm is occurring,” she writes.

Sometimes the wisest choice is doing more by doing less.

We gave some good advice for getting second opinions in a recent issue of our Better Health Care newsletter. We explained why many of us, even medically sophisticated consumers, hesitate to get second opinions. We discussed the multiple ways second opinions are helpful, even when they result in confirmation that the original plan was a good one. And we described ways to make the second opinion consultation more productive.

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