When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits
In order to produce a mathematical model for better understanding of the benefits and utilization of second opinions and to understand the contradiction between the value of second opinions and their perceived underuse, we developed an expected utility theory model to quantify their value. We use a...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-04-01
|
| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454821000333 |
| _version_ | 1819138801466867712 |
|---|---|
| author | Michael Halasy, DHSc, MS, PA-C Jason Shafrin, PhD |
| author_facet | Michael Halasy, DHSc, MS, PA-C Jason Shafrin, PhD |
| author_sort | Michael Halasy, DHSc, MS, PA-C |
| collection | DOAJ |
| description | In order to produce a mathematical model for better understanding of the benefits and utilization of second opinions and to understand the contradiction between the value of second opinions and their perceived underuse, we developed an expected utility theory model to quantify their value. We use a case-based example to find types of biases that could affect second opinions. Although the baseline expected utility theory model presented assumes providers are rational, we relax this and discuss the implications for how these alternative specifications alter predicted use. We found that second opinions are valuable when diagnostic accuracy is variable across physicians or access to high-quality care is restricted. In a stylized simulation example in which about half (50.1%) of diagnoses were incorrect, receipt of 1 second opinion reduced the error rate to 25.8% and receipt of 2 second opinions reduced the error rate to 16.0%. After incorporating potential biases into the model, the value of second opinions increases only when aversion to changing the initial diagnosis is greater than aversion to correcting a mistake. Additionally, this model reveals that second opinions have value even when diagnostic accuracy is perfect. Further, when financial incentives differ from the incentives of the initial consult, a second opinion offers patients a reasonable bound of their treatment options. To conclude, we identify numerous reasons for underuse of second opinions. Specifically, value depends on the degree of diagnostic uncertainty, presence of behavioral biases, and variation in local compensation regimes. Despite their value, recent trends could actually decrease the value of second opinions. |
| first_indexed | 2024-12-22T11:12:32Z |
| format | Article |
| id | doaj.art-f5b22f7c6d974681b80ed60576f60139 |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-12-22T11:12:32Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-f5b22f7c6d974681b80ed60576f601392022-12-21T18:28:07ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482021-04-0152502510When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion VisitsMichael Halasy, DHSc, MS, PA-C0Jason Shafrin, PhD1College of Medicine, Spine Center, Mayo Clinic, Rochester, MN; Correspondence: Address to Michael Halasy, DHSc, MS, PA-C, College of Medicine, Spine Center, Mayo Clinic, 200 First St SW, Rochester, MN 55902.Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CAIn order to produce a mathematical model for better understanding of the benefits and utilization of second opinions and to understand the contradiction between the value of second opinions and their perceived underuse, we developed an expected utility theory model to quantify their value. We use a case-based example to find types of biases that could affect second opinions. Although the baseline expected utility theory model presented assumes providers are rational, we relax this and discuss the implications for how these alternative specifications alter predicted use. We found that second opinions are valuable when diagnostic accuracy is variable across physicians or access to high-quality care is restricted. In a stylized simulation example in which about half (50.1%) of diagnoses were incorrect, receipt of 1 second opinion reduced the error rate to 25.8% and receipt of 2 second opinions reduced the error rate to 16.0%. After incorporating potential biases into the model, the value of second opinions increases only when aversion to changing the initial diagnosis is greater than aversion to correcting a mistake. Additionally, this model reveals that second opinions have value even when diagnostic accuracy is perfect. Further, when financial incentives differ from the incentives of the initial consult, a second opinion offers patients a reasonable bound of their treatment options. To conclude, we identify numerous reasons for underuse of second opinions. Specifically, value depends on the degree of diagnostic uncertainty, presence of behavioral biases, and variation in local compensation regimes. Despite their value, recent trends could actually decrease the value of second opinions.http://www.sciencedirect.com/science/article/pii/S2542454821000333 |
| spellingShingle | Michael Halasy, DHSc, MS, PA-C Jason Shafrin, PhD When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits |
| title_full | When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits |
| title_fullStr | When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits |
| title_full_unstemmed | When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits |
| title_short | When Should You Trust Your Doctor? Establishing a Theoretical Model to Evaluate the Value of Second Opinion Visits |
| title_sort | when should you trust your doctor establishing a theoretical model to evaluate the value of second opinion visits |
| url | http://www.sciencedirect.com/science/article/pii/S2542454821000333 |
| work_keys_str_mv | AT michaelhalasydhscmspac whenshouldyoutrustyourdoctorestablishingatheoreticalmodeltoevaluatethevalueofsecondopinionvisits AT jasonshafrinphd whenshouldyoutrustyourdoctorestablishingatheoreticalmodeltoevaluatethevalueofsecondopinionvisits |