By Nancy Papesh, RN, BSN, MBA, and Cynthia Horner, MD, FAAFP
Dan didn’t know definitively what he had, but he knew enough to be scared. He had always been an active biker and walker. But then, at the age of only 60, he found he could no longer keep up with his wife, kids, and grandkids.
His MRI and bloodwork pointed to a rare disease called AL amyloidosis that affects just eight in every 1 million people, about 4,000 new cases per year. His biopsies came back negative, though, and his oncologist wouldn’t treat him without a definitive diagnosis. Dan knew AL amyloidosis could be deadly in months without treatment.
Desperate, Dan did something he had never done before and reached outside his home state of Georgia virtually to seek a second opinion. It worked—he got the diagnosis he needed. Now, Dan is receiving the appropriate medical attention and credits the virtual second opinion with saving his life.
Dan is fortunate in that he is still capable of managing his own care. Not everyone is mentally or physically strong enough to do so, and you can easily imagine any number of situations where a loved one has a difficult diagnosis with attendant care responsibilities. Perhaps your parent is suffering from Alzheimer’s disease or another form of dementia. Maybe your sibling has a progressively debilitating condition such as multiple sclerosis. Or maybe your child is diagnosed with a rare form of cancer.
Benefits of a second opinion
Your loved one is likely already receiving high-quality medical care for their condition. However, there may be times when you or your loved one desires a second opinion, like Dan. Perhaps your loved one has a condition that, despite treatment, isn’t improving or is getting worse; perhaps they have been diagnosed with a serious or rare health condition or have been told their condition is not treatable; perhaps they are facing treatment that involves significant risks, such as surgery or chemotherapy.
Second opinions are also appropriate when you or your loved one wants a confirmation of a diagnosis or of a particular treatment approach. For instance, 72% of cases where second opinions are obtained result in a potential diagnosis change or recommended treatment plan modification. The American College of Surgeons (ACS) recommends patients obtain a second opinion before undergoing surgery if they have any doubts regarding the procedure. “Consultation has always been a part of good medical practice, and a competent physician should not be insulted if you decide to get further advice,” the ACS states.
Other reasons for wanting a second opinion include making an informed decision about medical care or obtaining a greater sense of control and peace of mind.
Whatever the reason, second opinions are medically and emotionally valuable. In fact, the American Medical Association’s (AMA) code of ethics requires AMA members to respect a patient’s right to obtain a second opinion on all health matters.
Challenges to obtaining a second opinion
Specialty care “deserts” make it hard to schedule an appointment with the right specialist for a single opinion related to your loved one’s condition, let alone a second opinion. Today, more than one-third of Americans live in a county that does not offer adequate access to primary care providers, hospitals, pharmacies, or trauma centers. This situation is likely to become worse, as 100,000 physicians are projected to leave the medical profession by 2025. When it comes to specialty care, access to a specialist who can meet your healthcare needs varies dramatically across states.
Even when specialty expertise is available locally, getting an appointment with a specialist can take weeks or even months, and gathering the necessary medical records can be complicated and time consuming. As you balance other obligations, such as work and/or caring for your own family, finding the time to obtain a second opinion can be difficult.
Many people are uncertain where to find an appropriate specialist for their case or are faced with long travel distances to obtain an in-person consultation. In these cases, virtual care can make a significant difference for caregivers. Virtual care facilitates connections to the right specialist at the right time by removing geographical constraints to specialty physician visits.
Telehealth is no longer simply a vehicle for one-off visits or limited to urgent care needs. Instead, today’s virtual care experience offers a pathway to a 360-degree care journey. With digital advancements in care delivery, individuals can receive treatment or consultation for their physical and mental health needs, no matter how long they’ve been dealing with them or where they live. Now, these technological advancements are opening the door to virtual second opinions.
Just like all telehealth visits, virtual second opinion (VSO) programs enable patients and caregivers to receive medical advice on complex conditions—anywhere in the world. Growing in popularity, these programs offer the advantage of not having to leave home, and some even offer faster appointments. The best programs also relieve patients and their caregivers of the complex and time-consuming efforts required to gather medical records from multiple sources.
Choosing a VSO program
Not all VSO programs are created equal, but the best programs have a few characteristics in common. For example, a first-rate VSO program offers specialists in many diseases and conditions, ranging from cancer and cardiology to digestive diseases and musculoskeletal disorders. These specialists also have knowledge of even the rarest of conditions, in both adults and children.
The highest-quality VSO programs offer prompt, one-stop access not just to one or two specialists in your loved one’s condition, but also to the surgeons, oncologists, and other subspecialists that your loved one’s care may require. This can greatly reduce the hassles of scheduling in-person appointments with multiple providers. With some lower-quality programs, patients and their caregivers might get a specialist appointment within days or weeks, but then face months waiting for subspecialist appointments to “close the loop” on their second opinion.
A high-quality VSO program should assign each patient a clinical care team led by a nurse care manager who manages every aspect of the VSO process. This includes gathering all relevant medical records from disparate sources, ranging from provider offices and hospitals to outside imaging clinics and labs—a cumbersome process for caregivers even under the best of circumstances.
Finally, many VSO programs only offer a written report that may or may not be accompanied by a telephone consultation with the specialist. This can feel impersonal and uncomfortable. In addition, questions may occur to you afterward that you didn’t think to ask in the midst of the consultation. A top-flight VSO program should offer caregivers and their loved one the opportunity not just to speak directly with the specialist via a video call, but also to receive a written report and ask follow-up questions.
At-home care support following diagnosis
The value of virtual access to specialty support doesn’t end with a diagnosis—in some cases, it’s just the beginning. Depending on the diagnosis, patients may need regular check-ins, follow-up visits, and consistent monitoring.
Oncology lends itself especially well to virtual settings. While some appointments still need to be conducted physically, much of the ongoing care required for cancer patients can be done virtually. Given that one out of four cancer patients travel an hour for consultations and treatment—and 8% travel two hours or more—virtual options ensure your loved one receives not only the appropriate care, but also the needed support at each stage of their care journey. With many illnesses making it difficult or uncomfortable to travel long distances, the ability to see your doctor from the comfort of home—or wherever you are—can greatly improve quality of life.
Virtual tools facilitate the connection with medical experts to get the answers patients need to feel comfortable with care decisions. They can also facilitate behavioral health and specialty care access during and after treatment. Most patients suffering from a significant chronic, life-threatening, or rare disease find their need for support extends beyond the boundaries of treating the primary disease. VSO programs can help by ensuring ongoing integrated support for all the complex needs a person might have.
Peace of mind
A high-quality VSO program provides caregivers and their loved ones the knowledge that they are accessing the highest-quality coordinated care available. Dan doesn’t believe he would be here today without the second opinion he received, and he is thankful for the extra time with his family.
Nancy Papesh, RN, BSN, MBA, is the director of clinical operations at The Clinic by Cleveland Clinic. Cynthia Horner, MD, FAAFP, is the medical director for Amwell.