Objectives: The number of second opinions in orthopaedic surgery is increasing rapidly, yet the grounds on which patients and their doctors decide to seek a second opinion have been little studied. The goal of the study was to identify patient and consultant factors that appeared to contribute to a second opinion being sought.
Methods: Two thousand and seventy-nine consecutive new patients visiting an orthopaedic surgical outpatient clinic in 1996-1997 participated in the study. Patients were self-defined as seeking a second opinion if they had visited at least one other consultant for the same condition within the previous two years. Each of these patients completed a questionnaire before seeing the orthopaedic surgeon; this included details about the physician-patient relationship, reasons for seeking a second opinion and perceived health status. The first-opinion consultants were contacted by mail; their practice characteristics and the motives for seeking a second opinion were also obtained.
Results: Thirty per cent of the study population (n = 625) had sought a second opinion. Patients sought a second opinion because of disappointment concerning their original treatment, or because they wanted more information about their condition and/or its treatment. First-opinion consultants were usually unaware of these communication issues. Patients' inclination to initiate a second opinion was best predicted by their evaluation of their relationship with their first-opinion consultant. The propensity to initiate referrals for a second opinion varied widely among the first-opinion consultants (10-70%) and was inversely proportional to the size of the group they worked in and their distance from the referral centre.
Conclusions: Patients did not seek a second opinion because they had doubts about the competence of their treating consultant, but because they were dissatisfied about the level of communication or about the results of their treatment. Medical educators should continue to increase their efforts to improve specialists' communication and relationship skills since these seem to generate referrals for second opinions, which occupy clinic space that could be used by other patients.