Second Opinions is one of the efficient medical procedures to enhance quality and
reliability of health care system, particularly from the patient’s point of view. To be
applied in Thailand, this will provide evidence of our patient’s rights enhancement as
well as consumer empowerment, in terms of allowing consumers to receive better
quality of health care services.
The objective of this study is to review the literatures related to Second Opinions and
people’s access to public health information, with the aim to find out preliminary
information required for a proper development of Second Opinions System in Thailand.
From the literature review, Second Opinions has been initiated and implemented
formally in the USA since 1970s. Initially, Second Opinions was used as a utilization
review technique to reduce unnecessary costs associated with overused and
inappropriate surgeries rather than used as an approach to offer additional information
or other further medical opinions to patients.
Nowadays, in most countries, Second Opinions is adopted and used based on the same
common principle, which regards Second Opinions as a fundamental right of patients to
get reassurance, additional information, as well as other treatment options from health
care service providers, except in the USA where the importance is also given to cost
benefits obtained from implementing the program. It can be seen that, in practices,
there are differences in intensity and scope of regulation imposed regarding the
application of Second Opinions among the studied countries. Some countries have
published state laws regulations to support the implementation of Second Opinions
program. On the other hand, some countries see Second Opinions as a typical issue in
medical ethics that every practitioner needs to follow, thus no need to use law
enforcement.
The methods of obtaining Second Opinions in the studied countries are similar among
each other, but the number of usage and effectiveness of each method are varied
according to various fundamental factors in each country such as education level of
population, technology development, state regulations, and local cultures.
In the present, Thailand has the declaration of patient’s rights as the main mechanism to
move forwards to the establishment of Second Opinions System. However, other
supporting mechanisms still need to be developed in order to ensure the system
effectiveness. The Second Opinions adopted for Thailand should be on a voluntary
basis, giving focus to the patient’s right to make decision, rather than on a mandatory
basis. Under this voluntary basis, patients will have an automatic right to request
second opinion directly from their attending doctors.
The recommended framework for the development of Second Opinions System are as
following 1) Driving: using laws/regulations, documented medical ethics, and public
relation to strive for public awareness; 2) Implement & Control: related public health
assurance units should be assigned to oversee the implementation as well as control the
costs incurred from operating the program; 3) Support: the proper development of
public health information system and coordination units/centers would provide
supporting infrastructure to the adopted system. Under this framework, there are
numbers of involved activities such as regulation amendments, public relation, database
set-up, further study on cost, etc. Then, after the system has been established,
concerned government agencies should relay information to the public through the
effective public relation program and then continually follow-up the implementation
closely in order to evaluate its effectiveness and eliminate the problems occurred.
Although, this report gives preliminary ideas and information required for a
development of Second Opinions System in Thailand, many further studies also need to
be conducted to give full details of pro’s and con’s of having such system prior to
making a go/no-go decision.