Medical 2nd Opinion – Trends & Challenges

The relation between a physician and the patients is often a complex one. There is an unwritten contract between the two. The association is based on trust from the patient’s side and the fulfilling of that by the physician. At times it may lead to disappointment (read misdiagnosis) but that doesn’t necessarily adhere to the fragile yet a tensile strength in the relation. Having said, this unwritten contract disallows the patient to see any other doctor without a referral note from his doctor, yet it also enjoins him to respect the autonomy of the patient, if the patient so desires, to seek a second opinion. 

A second opinion is a decision-support tool for ratification or modification of a suggested treatment, by another physician. It represents a Novel Advancement in Modern Healthcare Services. As healthcare delivery shifts to a patient-controlled model of care, expert Second Opinion is poised to lead that transition, preventing diagnostic errors, saving cost and avoiding wrong treatments which can have lethal consequences. Many diseases are inherently complex and there are no clear answers either in terms of exact diagnosis or the best course of the intervention. In certain cases, the physician responsible for the patient’s care might lack the much-needed expertise. The problem can be further magnified with misplaced egos and a revenue-driven approach that hospitals resort to (A recent report jointly conducted by FICCI & EY, mentioned that 60 per cent of the patients surveyed said that “Hospital don’t act in our best interest”). Finally, it could simply be a lack of time or fatigue that might lead to an incorrect diagnosis. After all, at 1:1200, the doctor-patient ratio in India is very low as compared to the countries with advanced healthcare (1:300 in the USA). The outcome can be disastrous for patients.

Traditionally, the concept of the second opinion is based on certain assumptions. First, that the physician has studied the patient’s medical history properly and as a family doctor (if the physician is so), he has a fair idea about the medical and the socio-economic information on the patient and his family. Second, the physician has to be knowledgeable about the various specialists in the town/city and has to ascertain their credibility and quality as professionals. Were the patient to consult another physician on their own then these benefits offered by their family doctor/1st physician consultant is lost. Having said, second opinions are not sought on these principals. One of the biggest challenges that the industry faces today, is that of the flitting patient – who moves from one doctor to another, obtaining a variety of opinions, often conflicting. Without anyone doctor in overall charge of the therapy, they may choose to accept whatever advice that is given to them. The problem is also compounded by the absence of clear-cut guidelines on the use of 2nd opinion in India.

Common Areas where the second opinion mostly sought are in the field of Cancer, Organ transplant, Cardiovascular, Neurological illness, Pre- surgical advice etc. It nevertheless helps if there is a system or an organization or a body who does the work of bringing in an expert panel of stellar doctors’ whose credibility doesn’t need to be double-checked. Foreign experts having commendable records can also be sought for consultation and all these can be made available just at the click of a button. There is a new paradigm being created and patients can now avail of best experts in the field at a fraction of the cost.

With the advancement of technology, most of the user records are available in a digital format. This makes it convenient to transmit high-quality data to doctors and get an online diagnosis done. Skype too can be used for diagnosis, cutting away the time period and making it convenient for patients. With changing lifestyles, the healthcare industry in India is also encountering paradigm shifts. Today, the accessibility of common people to the best available talent in the country and globally along with transparency in clinical management is not a distant dream.

Dr Inder Maurya

Guest Author The author is Founder & CEO, Foreign OPD.