In the past, I’ve blogged about how online services let patients seek a second opinion from home. Now, CNN Medical Correspondent, Elizabeth Cohen, has written a nice article on obtaining a second opinion online. An online second opinion has the potential of eliminating the hassle and expense of out-of-town travel. But, before seeking one, think carefully about cost and questions for the doctors before you click your mouse. Remember, second opinions will likely not give you all the answers
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In August, just days before her daughter was to start her sophomore year of college, Dr. Lucy Sauer faced a troubling choice: Should her daughter have a device surgically implanted in her chest to control her heart rhythm?
One doctor, a cardiologist, told Sauer that her daughter, Hannah Remmel, “absolutely” needed a defibrillator. He said an MRI of Remmel’s heart showed a rare congenital deformity, and he feared that she might die without the device.
But Remmel’s primary care physician wasn’t so sure. He doubted Remmel even had the deformity. Sauer, a family physician in Little Rock, Arkansas, needed clarity.
“I didn’t want to drag Hannah home from her college in Florida to get a second opinion here. But I also didn’t know any doctors in Florida she could go to,” Sauer says. “So I went online.”
Two weeks and $565 later, Sauer had her answer from the Cleveland Clinic’s online second opinion service: Her daughter’s heart was just fine. She had no deformity and no need for heart surgery.
Remmel never actually saw Cleveland Clinic doctors; they examined her MRI images and test results from the Little Rock cardiologists.
“I was so relieved,” Sauer says. “It was fabulous.”
“I’m really impressed with these services,” says Dr. John Santa, director of the Consumer Reports Health Ratings Center. “They provide access to some of the most knowledgeable specialty physicians in the world.”
But getting a second opinion isn’t simply a mouse click away. You have to make sure you send the right information and ask the right questions. Here are the five steps to getting a good second opinion — one that’s worth your time and money. Step One: Go to these Web sites
Two major, world-class hospitals currently offer online second opinion services to patients nationwide: the Cleveland Clinic and Partners Online Specialty Consultations, which is affiliated with Massachusetts General Hospital.
Step One: Go to these Web sites

Two major, world-class hospitals currently offer online second opinion services to patients nationwide: the Cleveland Clinic and Partners Online Specialty Consultations, which is affiliated with Massachusetts General Hospital http://topics.edition.cnn.com/topics/massachusetts_general_hospital.
Step Two: Consider the cost

Insurance often won’t pay for online consulting services, so make sure you understand the costs up front.
The Cleveland Clinic  charges $565 for an online second opinion. If a pathologist is needed (with cancer, this is usually the case), there’s an additional charge of $180.
Partners charges $495 for a second opinion that doesn’t require the services of a radiologist or pathologist. It costs an extra $200 to have a radiologist read an image, such as an X-ray or MRI, and an extra $250 for a pathologist to examine a specimen.
Step Three: Ask the right questions

Since much of your communication will be by e-mail, you can take the time to think through exactly what questions you need answered.
“I wrote out my questions very carefully,” Sauer says. “I wanted to make sure I would get very specific answers.” She also had her family physician review the questions. “You’re emotionally involved, so get someone to read over your questions, even if it’s just a friend or family member.”
Jon Linkous, CEO of the American Telemedicine Association, says it’s crucial to ask whether the doctors have all the information they need to issue their second opinion.
And, make sure you know who to call if you have any questions after reading your doctor’s report.
Step Three: Ask the right questions

Since much of your communication will be by e-mail, you can take the time to think through exactly what questions you need answered.
“I wrote out my questions very carefully,” Sauer says. “I wanted to make sure I would get very specific answers.” She also had her family physician review the questions. “You’re emotionally involved, so get someone to read over your questions, even if it’s just a friend or family member.”
Jon Linkous, CEO of the American Telemedicine Association, says it’s crucial to ask whether the doctors have all the information they need to issue their second opinion.
And, make sure you know who to call if you have any questions after reading your doctor’s report.
Step Four: Ask about conflicts of interest
Whether you’re getting a second opinion online or in person, find out whether the doctor has a financial interest in the treatment he or she is recommending, Santa advises.
For example, if a doctor recommends a specific device, ask whether he or she has a financial relationship with the company that makes the device.
Step Five: Realize that the second opinion might not solve all your problems

This was the case for Hannah Remmel.
Remmel had an MRI of her heart in the first place because she’d been having frequent fainting episodes. The Cleveland Clinic’s second opinion answered one question — she doesn’t need a defibrillator — but still no one’s sure what’s causing her fainting.
Sometimes, Linkous says, more complex problems can’t be solved online.
“There are cases where a patient really needs to go see a doctor,” he says.