Second Opinion

A second opinion is a review of your diagnosis and recommended treatment by a different doctor, usually a specialist, before you go ahead. It can be an in-person visit or a records review by an expert at a large medical center, and many employer plans now cover it at no cost through a second opinion program. Medicare and most insurers will pay for a second opinion visit as a normal consultation, and some plans require one before certain elective surgeries.

The evidence for doing it is strong. When the Mayo Clinic reviewed 286 patients referred for a second opinion, the final diagnosis was different from the original in about 21 percent of cases and refined in another 66 percent; only 12 percent were confirmed exactly. Expert-review programs used by large employers report that roughly 25 to 40 percent of recommended surgeries, particularly spine fusions and some orthopedic procedures, are changed to a less invasive plan after review. That is a quality question first, and a cost question second: a spinal fusion the plan did not need to pay for is $80,000 to $150,000, and the employee avoided a surgery with a long recovery. In my experience, patients hesitate because they do not want to offend their doctor. Good doctors expect it.

The takeaway: before any surgery that is not an emergency, get a second opinion, and check whether your plan has a program that arranges one free. Ask the second doctor a specific question: "What would you do if this were your family member?"