이차 의견과 닥터 쇼핑

Second opinion and doctor shopping

Second opinion seeking and doctor shopping are common, but understudied medical phenomena. The prevalence of second opinion seeking and doctor shopping varied widely according to medical conditions, and are reported to be around 6.5%~36% and 6.3%~56%, respectively. Dissatisfaction with or distrust of first opinion doctor is the most important reasons for such phenomena, but other factors related to patients’ own condition or characteristics also contribute. Second opinions frequently discord with first opinions, and often change the diagnosis or treatment recommendation, although the degrees of the discrepancy widely vary with specialty. Most patients reported high satisfaction with the second opinion process, and became more confident with their diagnosis or treatment options. Second opinion can sometimes induce duplicate tests, but also have potential to reduce unnecessary procedures. There is no good evidence on whether second opinion actually improves the quality of care or patient outcomes. With increasing demand for second opinion as well as the trend for patient autonomy and consumerism, there is a need to establish a well-designed second opinion program. However, there are many practical, legal, and ethical issues which need to be discussed. In addition, it should be emphasized that a health care system which can ensure first opinion based on evidence-based clinical guideline and also enhance enough communication between the physician and the patients in order to prevent patients’ dissatisfaction and subsequent unnecessary second opinion seeking or doctor shopping.