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Abstract
This dissertation presents a typology of second medical opinions based on an inductive qualitative analysis of interviews with 151 respondents. It identifies three types of second opinions: patient-initiated, convenient, and unsolicited. Patient-initiated second opinions occur when patients actively seek out alternative expert advice. Convenient second opinions arise during encounters initially scheduled for a separate concern, and patients opportunistically ask providers to address a medical issue for which they had previously received advice. Unsolicited second opinions can arise when patients change providers due to external circumstances—such as the retirement of a previous physician—potentially leading to conflicting medical advice. Second opinion types shape how patients navigate care choices, particularly when medical opinions conflict.
I argue that second opinions—regardless of how they occur—can expand patients’ medical knowledge. They offer opportunities to observe new diagnostic approaches and can expose patients to alternative treatment options. Patients can draw on the knowledge gained from the second opinion to make informed judgments between conflicting expert opinions. Even when not deciding between treatment options, they can use this information to critically assess their previous providers’ expertise. Second opinions also allow patients to experience the different approaches physicians take to patient care and communication, and through comparing different personal qualities between physicians, patients can select a provider who is a better fit for their preferences and needs. However, the information patients receive from a second opinion—and how they use that information to make medical decisions—varies depending on the type of second opinion. Moreover, not all second opinions are desired, accepted, or beneficial to patients. Patients who received an unsolicited second opinion were more likely to reject the advice from the second opinion provider than other patients. The typology I propose sheds light on the conditions under which second opinions are welcomed, prove useful, or are ultimately dismissed. These findings illustrate how second opinions influence patient decision-making, expose patients to novel medical information, and affect their choice of medical experts.