Second Opinions

An associate who edits a health newsletter sent me the following email and article yesterday:

Jeff:

I read your comment on my post... I take your point that a lot of surgery, specifically
CABG, may not be necessary. Worse, it may be driven by
cardiologists' hubris, reflex or greed.

Attached is a 20-year-old article I ran across tonight after
browsing your blog. A second opinion is always a good idea, even
if it's forced -- as in your case -- by a much-maligned insurance
company beancounter.

...I struggle with how hard it is to
differentiate between evil intent, systemic conflicts of
interest, and just plain laziness in analyzing medical decisions.

Congratulations on taking control of your health, and on the good
things that seem to be happening to you with your Angel.


Here is the article that was originally published in the JAMA in 1987:

SECOND OPINIONS FOR CORONARY BYPASS SURGERY ARE BENEFICIAL.

Third party payers now frequently require candidates for coronary artery bypass graft (CABG) surgery to get a second opinion before the operation is performed. Graboys and colleagues describe their experience with 88 such patients, all of whom had been recommended for CABG by another cardiologist. The investigators recommended that CABG be deferred in 74 of the patients, and 60 of these patients did not undergo surgery. No fatalities occurred during the follow-up period of 27.8 months.

These data support the use of second opinion programs and suggest that medical therapy alone offers a good prognosis for many patients. This study does not provide evidence that a large percentage of CABG operations are unnecessary, but it shows that the decision to proceed to surgery should be made cautiously.