title: Patient-initiated second medical opinions: their necessity and economic cost.
abstract: OBJECTIVE
  To assess the value of patient-initiated second medical opinions (SMO).
  
  
  METHODS
  The authors prospectively collected demographic data from 100 consecutive patients. The authors recorded major changes in the patients' care, such as inappropriate surgery recommended, inadequate treatment performed, and appropriate treatment not recommended. The authors also recorded costs incurred or saved by the patients and the third-party payers.
  
  
  RESULTS
  In nearly 15 of the cases, the authors had major disagreements with the initial diagnosis or management. Surgery had been recommended in 28 cases. They advised against it in nine. In 72 cases, no surgery had been recommended. They advised and performed it in five. The management of five other patients was not in accordance with that recommended by large clinical trials or was inadequately done. Including the consultation fees, surgery performed or advised against, retinal angiography, and ultrasonography, the 100 SMO cost third-party payers $12,426. If the authors subtract the cost of noncontroversial surgery they recommended and if the patients had paid the consultation fee and had brought along their fluorescein angiograms, third-party payers would have saved $4,079.
  
  
  CONCLUSIONS
  The savings SMO generated by eliminating unnecessary surgery resulted in improved patient care at minimal cost to third-party payers.
authors.affiliation: Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Benson
authors.forename: C D
authors.initials: CD
authors.lastname: Regillo
authors.forename: J F
authors.initials: JF
authors.lastname: Vander
authors.forename: W
authors.initials: W
authors.lastname: Tasman
authors.forename: A F
authors.initials: AF
authors.lastname: Smith
authors.forename: G C
authors.initials: GC
authors.lastname: Brown
authors.forename: A C
authors.initials: AC
authors.lastname: Ho
authors.forename: J A
authors.initials: JA
authors.lastname: McNamara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000191:economics; D010414:Pennsylvania; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data*; D012164:Retinal Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery