Second opinions can optimize outcomes and avoid needless expenses

Mary Rockland was in a panic when she learned that she was diagnosed with invasive breast cancer. Like many patients, she trusted her doctor when he told her that a lump in her breast was cancerous, and relied on his judgment when he recommended a bilateral mastectomy. However, after Mary attended an appointment for a second opinion and her pathology was reviewed by two experts, she learned that her actual diagnosis was atypical ductal hyperplasia – an abnormal cell growth that is not cancerous. Outpatient lumpectomy removed all suspicious tissues and she avoided a more invasive surgery and chemotherapy, as well as the anxiety and cost of cancer surveillance for a lifetime.

Unfortunately, Mary's story is not uncommon. According to a recent study in BMJ Quality and Safety, about 12 million adults are misdiagnosed each year in the United States. That equates to about one in 20 patient encounters resulting in a misdiagnosis. Even more patients are prescribed a treatment plan that is not the best course of treatment for their condition. One of the simplest ways to ensure that your diagnosis and treatment plan are correct is to get a second opinion.

PinnacleCare, a leading health advisory firm, studied the impact of an expert second opinion on medical outcomes. Researchers collected data on 1,000 cases over a three-year period and found that almost 77 percent of medical interventions led to changes in diagnosis, treatment, and/or treating physician.

With more health care decisions increasingly in the hands of consumers who are busy and ill-equipped to make important medical decisions, the potential for misdiagnosis or improper course of treatment will most certainly increase.

"With all of the inherent complexities in the healthcare system, it's imperative that people actively do everything they can to ensure they're getting the very best care possible," said Dr. Miles Varn, chief medical officer of PinnacleCare. "Medicine is still an art subject to human error or interpretation. You owe it to yourself to see the physician with the expertise, skill and experience for your specific condition."

PinnacleCare gathered data on patient outcomes from their interventions over a three-year period. In a sampling of 1,000 cases with known outcomes from 2012-2014, 41% resulted in transfer of care to a COE or expert provider with 34% resulting in a change in diagnosis, treatment, and/or course of care. A total of 18 patients were able to avoid unnecessary surgery as a result of a PinnacleCare intervention.

This data demonstrates the potential for health advisory services and second opinions to optimize outcomes and avoid needless expense. One of the persistent challenges in health care today is access to expert physicians. With consumer directed health care plans, the value of health advisory services becomes even more evident as consumers struggle with vetting appropriate providers and treatment options for their complex conditions while seeking timely access to the care that they need. PinnacleCare is committed to providing objective, concierge-level support with the expert resources and access needed to help consumers tackle these complex challenges.