Insist on a Second Opinion... Your Own

Why are patients in Casper, Wyo., nearly seven times more likely to undergo back surgery than patients in Honolulu, Hawaii?

Why are women in Grand Forks, N.D., seven times more likely to have a mastectomy for early-stage breast cancer than women in San Francisco?

Why are men in Miami 15 times more likely to receive a PSA test than men living in Lebanon, N.H.?

Those are questions raised by the release of reports compiled by researchers at the Dartmouth Institute for Health Policy & Clinical Practice.

After comparing elective surgeries in nine regions across the country, they discovered remarkable variations in procedures, even though the patients had similar conditions.

Researchers concluded that the treatment a patient receives depends more on the physician’s recommendations than the patient’s preferences.

Patient preference is critical when facing a decision about a test or treatment involving more than one medically reasonable option. Ideally, it’s a shared decision.

According to Michael J. Barry, MD, co-author of the Dartmouth report, “When done right, shared decision-making results in a better decision: a personalized choice based on both the best scientific evidence and the patient’s values.”

Dr. Barry’s statement came in a press release issued by the Robert Wood Johnson Foundation, which funded the study as part of its ongoing mission to create positive change in the healthcare system.

Traditionally, patients rely on physicians to make health care recommendations in their best interest. But as the Dartmouth report suggests, physicians do not always get it right.

Part of the problem is consolidation of the healthcare system. Investment-minded hospitals are buying up medical practices, and displaced physicians are becoming hospital employees with economic incentives based on performance and efficiency.

Last December, the American Medical Association responded to this consolidation with a newly adopted policy statement addressing what it called the “divided loyalty” of physicians.

“A physician’s paramount responsibility is to his or her patients,” declared the AMA policy statement. However, it also stated that a doctor “owes a duty of loyalty to his or her employer,” and “this divided loyalty can create conflicts of interest, such as financial incentives to over- or under-treat patients.”

It would be unfair to say all doctors are beholden to personal economic interests. At the same time, it would be unwise to ignore the fact that these types of incentives exist and that they run contrary to fundamental principles for high-quality medical care:

1.      Avoid underuse

2.      Avoid overuse

3.      Eliminate misuse

A physician is just one member of your health care team. Now, more than ever, it’s important to insist on a second opinion—your own—as well as input from other trustworthy sources

How can you know whether you are getting the right amount of care – not too much and not too little? Here are some tips from Own Your Health, a campaign to empower individuals to make healthcare decisions that offer the best outcomes and best value for their healthcare dollars. Learn more at www.wacommunitycheckup.org/ownyourhealth

1. Talk to your primary care doctor.

2. Call the Ask Mayo Clinic nurse line (800-903-1836) for information and advice*

3. Ask questions.

4. Look for more information on your own.

5. If needed, get a second opinion from another doctor.