Getting second opinions saves lives and saves money

Jaclyn Lewis

When you’re injured or sick, the first medical diagnosis your doctor gives you may not be accurate.

“The main thing a second opinion can give you is hope,” said Samaritan Ministries member Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, in a MediBid webinar, “Second Opinions that Save Lives.” (You can watch the webinar recording featuring Dr. Orient and other panelists at bit.ly/opinionwebinar.)

A Mayo Clinic study shows that 88 percent of initial hospital diagnoses are changed or refined due to diagnosis error. This change in diagnosis also changes the patient treatment plan.

“It’s a healthy environment where different docs have different diagnoses for the same condition, if they will come together and talk,” said another webinar panelist, Dr. Kenneth Mattox, chief of staff and surgeon-in-chief at Ben Taub Hospital in Houston.

Several factors are involved in diagnosis

Doctors consider many factors when determining a patient’s diagnosis and treatment plan, including recovery time, implications of treatment, and cost. Getting a second opinion can ensure that you or your loved one gets the best diagnosis and treatment for their unique medical condition.

Dr. Mattox recalled a friend who contacted him for advice after his doctor had recommended heart transplant surgery. After reviewing his friend’s charts, Dr. Mattox explained to his friend that, if the man were his patient, he would recommend discontinuing certain medications to see if this resolved the heart problem. Four years later, Dr. Mattox’s friend never had heart surgery, is no longer on any medication, and feels better than when he first went to his doctor.

It’s crucial that hospital patients with common diagnoses, such as heart failure or pneumonia, get second opinions as well, since this often determines important end-of-life care. You may find yourself in a situation where you don’t feel your hospital physicians are “working in your best interest, do not know you from your past,” or “are not communicating with you,” Dr. Orient said.

“It could be that you’re elderly, but you were completely with-it, you were involved in life, you were taking care of yourself, until you became ill,” Dr. Orient said. “But you’re being taken care of by a hospitalist who doesn’t know you from before, who’s saying, ‘You really look like death warmed over. You’re not going to make it. We’re going to rush you into the hospice program.’”

Dr. Orient said this practice “may be to save the hospital money, or to save your managed care company or your ACO (Accountable Care Organization) money, when in fact someone who had some acquaintance with you before may say, ‘Well, let’s give this patient a chance.’”

She said that many of her colleagues report “that they’ve had patients they felt would’ve survived with normal … medical care.”

Intervention 'can really make a difference' between death and more years

Dr. Orient said that “having somebody who knows the patient and is willing to intervene and to maybe fight with the hospital doctor if necessary, just to have a little patience, just to do a few regular things, can really make a difference between an early death and having years of participating in the family and having a life that is valuable to the patient, even if it’s not of value to the government or the managed care company.”

“But now they’re being rushed off to hospice where they’re being denied fluid management, or routine cardiac drugs,” Dr. Orient said. With “a little bit of patience and a little bit of hope,” many of these people could continue to enjoy their lives and families.

“For some reason doctors these days are actually considering hope to be a bad thing to offer people because it might lead them to do things that are not going to work,” Dr. Orient said. “Of course, anything we do in medicine might not work.

“But many of us have had the experience of standing by a patient’s bedside at 2 o’clock in the morning. She looks like she’s going to die, lungs are filled with fluid, call the son to let him know that things are not looking good, maybe get a ‘Do Not Resuscitate’ order. But then I decide, ‘Well, as long as I’m here I’m going to give her a tad of morphine, and a little touch of a diuretic (which causes urination).’ And within two minutes the patient is pinked up, is breathing, is talking to me. She lived a fairly comfortable life for two or three years (more).”

Dr. Orient said it’s important to develop a good relationship with your doctor while you’re healthy. When your doctor knows you well, she can best advocate for you in the event you are injured or sick.

Samaritan members can get a second opinion via Medibid from the Health Resources Center by logging into your Dashboard account.

Dr. Jane Orient has served as executive director of the Association of American Physicians and Surgeons since 1989, and has been in solo private practice since 1981. She is president of Doctors for Disaster Preparedness and has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society since 1988. She has written six books and over 200 papers and op-ed pieces in scientific and popular literature, including YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare. You can read her Member Spotlight at SamaritanMinistries.org/drorient.

Dr. Kenneth Mattox is distinguished service professor at Baylor College of Medicine. Since 1973, he has served as chief of staff and chief of surgery at Ben Taub Hospital. He has written 600 articles, over 1,000 abstracts, and has written and co-written internationally bestselling medical textbooks, including Top Knife: Art and Craft in Trauma Surgery, a practical guide to trauma care translated into 10 foreign languages and praised by physicians in war zones as their “bible” in the operating room.

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