Second Opinions: How Should You Choose?

Dov Michaeli

Posted 5/9/12 on The Doctor Weighs In

Incredulous Dov

I have frequently been asked to render judgment on another doctor’s diagnosis, or treatment plan. Other times I am asked anxiously: “should I get a second opinion”? The implicit assumption in this sort of questions is that “two heads are better than one.” Or stated more broadly, we put our faith in the “wisdom of the crowd,” whether the “crowd” is made up of two or two-thousand individuals.

I have to admit I’ve had some nagging doubts about this all-encompassing wisdom. For instance, wisdom of the crowd has been amply documented in estimation tasks (“how many people in this crowd?  What is your estimate of the completion date of the project?”). The reason this works is that it exploits the benefit of error cancellation; the outlier estimates on either side cancel out each other and we end up with the consensus opinion, that is closest to the truth. But how do you decide when the issue is not quantitative? Think of the virtually unanimous opinion of the White House crowd to go to war in Iraq. Where was the “wisdom” there? More interesting, we could drill deeper and ask why is it that the crowd reached such a wrong decision? Wisdom of the crowd was hailed as a source of near-magical creativity and unparalleled wisdom and forecast accuracy. Some of these attributions have proved to be unfounded. For instance, with respect to creative potential, groups that engage in brainstorming lag hopelessly behind the same number of individuals working alone. The key to benefiting from other minds is to know when to rely on the group and when to walk alone. Wouldn’t it be nice if we had some sort of an algorithm to guide us in making this decision?

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Shared Decision Making – 2nd Opinions


Brian’s Note: Howard Luks MD produces short explanatory videos that are designed to clarify patient issues. We’re delighted to add his work to the patient- and clinician-centric resources here at C&C.

Not all findings on MRIs or X-rays require surgery. Quite the contrary, many do not. How do you decide? This video should help point you in the right direction to obtaining meaningful opinions, etc. If not, let me know why…

Good morning. Forgive the little bit of haze you may find in my presentation, that’s a residue of some Benadryl I took. It ripped myself of these Northeastern virus that’s been on misery especially in my family in the last week. And I have something to do with 30 inches of snow that we’ve dumped on us that everyone enjoyed yesterday. Anyway, that’s not what we’re here to talk to you about today. What I wanted to talk to you was about a short week of second opinions. Typically I see a number of people each week where I tend to see them as a second opinion —simply because I’m situated in a tertiary care or advanced level care institution and we are an academic center, so which means we train, that we train the next generation of surgeons and we tend to be a referral base for a very large catchment area.

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