Thursday, November 29, 2007

Second Opinions - Online - Worthwhile?

What would you say are the pros and cons of getting a second opinion online through institutions like The Cleveland Clinic and Partners Healthcare (through Harvard)?
Second opinions online or consultations without seeing or examining a patient are probably helpful if someone wants to have the blessing of a major medical institution like Cleveland Clinic. The other advantage is to get advice without traveling to these medical centers. While these second opinions have access to doctors’ notes, lab results, and imaging studies, these institutions don’t usually have their doctors examine the patients. This is the biggest potential problem of these programs.

Let’s for example say you wanted to buy a car. If you wanted to buy a car online, could you make an informed decision whether to purchase it based on its description (doctors’ notes) and pictures (imaging studies)? Would you be able to tell if the engine ran smoothly, the seats were comfortable, or the handling was just right based on the information you received online? For most people, doing the research and having bits of information isn’t a substitute for a test drive.

This is no different than having an online consultation. As doctors, one of the first things we learn is to treat the patient and not test results. People are more complex than simply blood tests, MRIs, and CT scans. Often pathology and radiology reports are qualified with the phrase “clinical correlation recommended”. This is the pathologists’ and radiologists’ way of telling the doctor who ordered the test to realize that the information they provided is only helpful in the context of the patient. Pathologists and radiologists know their limitations. Their expertise provides only a glimpse of the person and his medical condition. This is the main reason that medical students today still spend much of their time learning how to interview and examine a patient before they learn what tests to order.

If the online opinion was used to reaffirm another second opinion, where a patient was examined by a doctor, then this would be reasonable. It would be very concerning if this second opinion overturned or refuted a previous opinion particularly since the patient wasn’t examined. Doctor notes, test results, imaging reports provide only a partial picture of a patient or his condition.

No comments:


Related Posts with Thumbnails