Introduction: Patients seek a second medical opinion when their diagnosis is uncertain or when the treatment choices they face are complicated, unpleasant, or involve risks. Second opinions are becoming increasingly common and result in greater patient satisfaction, reduce rates of elective surgery, and save healthcare system dollars. Direct-to-consumer (DTC) telemedicine companies provide consumers around-the-clock access to care for common, nonemergency conditions through phone and live video via webcam or smartphone applications. One study demonstrate that these telemedicine consultations frequently result in a major change in treatment. No studies exist in the literature specific to second opinion services via telemedicine in otolaryngology.
Study Design: Retrospective chart review
Methods: We conducted a retrospective review of virtual second opinion consults reviewed by one ENT physician via a private telemedicine service. The patient cases spanned from September 2011 to March 2021. These second opinion cases involved patients requesting second surgical consults regarding thyroid nodules. Information on diagnostic workup and surgical recommendations made by patient’s original primary surgeon was collected for review by the telemedicine company. We compared these original workup and management decisions to all relevant guidelines published in the 2015 American Thyroid Association (ATA) Guidelines for thyroid nodules and differentiated thyroid cancer.
Results: 37 patient charts were reviewed—all of which were patients seeking care related to thyroid nodules. 28 patients were female (76%) and 9 (24%) were male, with ages ranging from 23-71 years. 23 of these patients were living within the United States but 9 were in Asia, 3 in Europe, 1 in Canada, and 1 in Africa. The majority of ATA guidelines were accurately followed. However, only 27 (73%) patients had TSH levels checked as per ATA guidelines. Fine needle aspiration was done per guidelines in 30 patients (81%) and molecular testing guidelines followed in 33 patients (89%). One patient was inappropriately guided toward surgery during her pregnancy. Overall, the surgical recommendations provided to patients were exactly in concordance with the guidelines in 27 (73%) cases. In 4 cases (11%) the surgical recommendations were against the published guidelines and in 6 cases (16%) the original recommendations were partially in agreement.
Conclusions: Virtual second opinion consults allow access to standard of care medical advice for patients all over the world. In our cohort of patients seeking virtual second opinions regarding thyroid nodules, the workup and surgical recommendations initially completed by the original surgeon were in compliance with the majority of ATA recommendations. In situations where discrepancies in proper workup or surgical recommendations were apparent, the virtual second opinion consult was valuable in allowing for additional treatment consideration to guide the patient's medical decision making.