ARE SECOND-OPINIONS OBJECTIVE? BIASES IN SECOND-OPINION CONSULTATIONS
Author(s)
Vashitz G1, Pliskin JS2, Parmet Y2, Kosashvili Y3, Ifergane G4, Wientroub S5, Davidovitch N21Technion Institute of Technology, Haifa, Israel, 2Ben Gurion University of the Negev, Beer-Sheva, Israel, 3Assaf Harofeh Medical Center, Zerrifin, Israel, 4Soroka University Medical Center, Beer-Sheva, Israel, 5Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
OBJECTIVES: Discrepancies in diagnosis, treatment or prognosis may emerge among physicians. A known decision-making bias is the tendency to shift personal opinion either towards or away from a previous opinion. We sought to evaluate such biases in the context of second-opinion medical consultations. METHODS: We distributed a survey questionnaire to a nationwide sample of orthopedic surgeons and neurologists. The questionnaires presented eight scenarios, each with conventional treatment options with no clear-cut preference. In four scenarios the physicians were told that a previous opinion had already been given by another physician, or that a second-opinion will be given, and the other four scenarios were used as controls. The physicians' responses were coded according to the level of intervention (conservative to interventional). RESULTS: 172 orthopedic surgeons and 160 neurologists filled out the questionnaires, which represent about 50% of these specialties in Israel. In the orthopedic questionnaire, when a first opinion had already been given, there was a shift towards a more interventionist treatment (p<0.05). This was especially prominent when the first opinion was known to the second physician. When the patient intended to seek a second-opinion, there was a shift towards a more conservative treatment. No such effect was found among neurologists. CONCLUSIONS: Physicians’ judgment may be affected by another physician’s opinion (compared to their choices without a first opinion). This bias mainly tends towards a more interventionist treatment. Due to the immense impact of any decision on patient health and resource use, further research should address such biases and develop tools to address them.
Conference/Value in Health Info
2010-11, ISPOR Europe 2010, Prague, Czech Republic
Value in Health, Vol. 13, No. 7 (November 2010)
Code
BI4
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Health Care Research
Disease
Multiple Diseases