Second Opinions Available Online

Aug. 22, 2001 -- An array of new drugs and treatment options have sent demands for second opinions soaring. And now, thanks to a new service, people can run to their computers instead of a doctor's office.

Three of Boston's top hospitals recently launched the service to sell second opinions online. Massachusetts General Hospital, Dana Farber Cancer Institute, and Brigham and Women's Hospital's offer links on their homepages to the "Partners Online Specialty Consultation" site.

The service hopes to ease a number of growing problems for patients who may question a diagnosis or treatment approach. It also hopes alleviate the long time it can take to get an appointment with a specialist, and the difficulties of hospital overcrowding.

"With waiting rooms full of people, we felt compelled to lead in this effort of understanding how we can best take care of patients. It's sort of a long view of how we can utilize this wonderful technology and take care of patients at the same time," says Dr. Joseph Kvedar, director of telemedicine for Partners HealthCare, which oversees Mass General and Brigham and Women's.

Along with convenience comes a price tag of $600 per case, which is not covered by insurance providers.

Not Your Typical Office Visit

In order to get a second opinion from one of the partners' sites, patients contact their primary care physicians, who formally request the assessment.

The patients must also fill out a registration form online detailing their medical history and submit it along with the payment. Primary care physicians then forward the necessary medical records — including any specialists' assessments that may have already been given — to the designated specialist to review.

The physician hears from the specialist within three business days, and discusses the results with the patient. (Most of the doctors in the service are not licensed to directly deal with patients in other states.)

Experts say the service is of great benefit to patients, especially those in rural areas.

"Patients will have access to high quality specialists and information that they might not have access to," says Kvedar. "Four thousand specialists are available, which is important especially if you're someplace in the world where that sort of depth of expertise doesn't exist."

Ethics a Question

Traditionalists may raise concerns over a doctor diagnosing without physically examining a patient, but Kvedar claims they're "well within the law" of ethical standards. Other experts agree.

"Looking at if from an ethical standpoint, it's not a bad thing at all," says Dr. Michael Groden, director of ethics at Boston University's School of Medicine. "What this is is the primary care doctor getting a second opinion. If you can't see the patient, this is probably the second best thing. You can learn an enormous amount from lab data."

Because the partners cannot advertise on other sites, they're relying on patient's searching the Internet for health information to find their site.

"One thing we suspect is there are a lot of folks out there who are having trouble finding a solution to their problems. We know that many who have health problems are looking online for help. Search engines may take them to the hospital sites, which have links to our site," says Kvedar. "This is part of a larger initiative, how much healthcare we can do out of our four walls. The demand will continue to grow rapidly."

The Cleveland Clinic in Ohio plans to launch a similar service by the end of the year.

While some patients may think the cost to use the service is too expensive, Groden thinks otherwise: "It would probably save a lot of money — paying $600 is probably a lot cheaper than getting a misdiagnosis. As long as it's done by a primary care provider, then it's a pretty good thing."