Becker's Hospital Review

42 CMO / CARE DELIVERY The art of the second opinion By Erica Carbajal and Gabrielle Masson S econd opinions are tricky. Patients who seek them oen have complex conditions, and physicians must exercise caution when delivering them to avoid further confusing patients who are already conflicted. And while it may seem self-evident to say that patients have a right to seek a second opinion regarding their medical care, it's oen important for physicians to remind them of this right, as fear of offending their original provider makes some patients reluctant to ask for a referral. But "patients owe it to themselves to get the most up-to-date and con- sistent information possible to provide themselves with the best op- tions for treatment," said Jeff Bahr, MD, chief medical group officer of Downers Grove, Ill., and Milwaukee-based Advocate Aurora Health. "As physicians, we expect our patients to seek second opinions, espe- cially for nonemergent illnesses such as rare diseases, cancer, heart conditions and neurological conditions," Dr. Bahr told Becker's. Moreover, research has shown second opinions lead to some level of change in treatment plans for the majority of patients who seek them. A Rochester, Minn.-based Mayo Clinic study from 2017 found as many as 88 percent of patients who sought out a second opinion at the health system le with a new or refined diagnosis that changed their care plan. Since second opinions have high-stakes potential to change patient outcomes, Becker's spoke to four physicians about best practices for navigating them. Emphasize the patient's right to seek a second opinion Some patients are hesitant to seek a second opinion, making it im- perative for physicians to support their right to do so, said Neveen El-Farra, MD, a professor of clinical medicine at the University of California Los Angeles and medical director for international ser- vices at UCLA Health. "Physicians will not be offended. We have to do a better job ensuring we are supportive of their choices," she said. "Physicians must empha- size the fact that this is your health, your body." For patients who seem to have lingering doubts or concerns, an add- ed boost of encouragement can be helpful and make them feel more comfortable initiating the second-opinion process. "When there's not a clearly superior treatment option or when I sense hesitancy from the patient, I try to remind them that they are wel- come to seek another opinion," said Eileen Crawford, MD, associate director of the orthopedic surgery residency program at Michigan Medicine in Ann Arbor. "I think it means a lot to hear that from the physician, and in many cases that gesture alone alleviates their doubts," she said. Physicians must be keenly aware of their demeanor when responding to patient hesitancy to ensure they don't inadvertently add stress to an already delicate situation. "ere's so much fear," Dr. El-Farra said. "Our role is to alleviate fear, make it less overwhelming and give patients options, peace of mind." What data from 20 systems shows about breakthrough infections By Mackenzie Bean P eople with diabetes, chronic lung disease or chronic kidney disease may be at increased risk for break- through infections compared to the general popu- lation, according to research from the health system-led data analytics startup Truveta. The startup, which now includes 20 health systems na- tionwide, launched its deidentified clinical data platform Nov. 9. The platform pools information from participating care sites to glean insights on medical conditions such as COVID-19 and rare diseases. For its first study, Truveta analyzed clinical data on more than 1.7 million fully vaccinated patients in the U.S. Re- searchers assessed trends in breakthrough infections and hospitalizations among those with chronic kidney disease, chronic lung disease, diabetes or those who are immuno- compromised, in comparison to people without any un- derlying health issues. Five findings to know: 1. Overall, breakthrough infection rates remained low among all groups studied, running from 0.9 percent for the general population to 1.5 percent for those with chronic kidney disease. 2. About 10 percent of people with breakthrough cases required hospitalization. 3. About 15 percent of Johnson & Johnson vaccine re- cipients were hospitalized for breakthrough infections compared to about 9 percent for people who received Moderna or Pfizer's shot. 4. People with chronic kidney disease had the highest hos- pitalization rate (26 percent) of all high-risk groups includ- ed in the analysis. 5. People who are immunocompromised did not have an increased risk for breakthrough infections compared to the general population in the study, which researchers said may be due to higher adoption of public health mea- sures like masking or social distancing. The research does not account for the timing of patient vaccination, previous COVID-19 infections and the timing of infections in relation to variants, which is a limitation, researchers said. n

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