The Doctor Will E-Mail You Now

That's what happened when Susan Walaska decided to seek an online second opinion. In her 40s, Walaska was diagnosed with a common heart condition called mitral valve prolapse, which often requires no treatment except routine examinations. In some cases, medication is used. Last summer, during a routine checkup, her local cardiologist told her she required surgery. "I was absolutely terrified," says Walaska, a 59-year-old education consultant from North Liberty, Iowa. "I was feeling fine, and I just didn't understand why surgery was recommended. I had absolutely no confidence in the treatment plan."

As she was cruising the Internet looking for information, Walaska came across the Cleveland Clinic's site and decided to get a second opinion. "To be honest, my doctors didn't discourage me from getting a second opinion, but they didn't actually encourage me either," she says. She believes her persistence paid off. Based on her medical records, the Cleveland Clinic's heart doctors told her that she didn't require surgery, at least for now. "I was absolutely thrilled," says Walaska. The hardest part of the experience was collecting her medical records. But once she got through that, "I felt empowered," she says.

Doctors seem to enjoy the process, too. Not only is it sometimes more efficient than an office visit, but it also helps them reach more patients in need. Like many specialists, Dr. George Demetri, director of the Center for Sarcoma and Bone Oncology at the Dana Farber Cancer Institute, gets many unsolicited e-mails from people asking for help. "Medicine is in the details, and you can't give an opinion when those details are lacking," he says. There is also the thorny issue of whether an e-mail response from a doctor to an unknown individual is even legal or ethical. "As a physician, you want to help as many people as you can," says Demetri. "Now [with Partners Online Specialty Consultations] we have a controlled way to provide our expertise to patients and their doctors no matter where they are. It just makes good sense."

The American Medical Association doesn't oppose online second opinions, but it does say in-person visits offer more benefits. "There is nothing that really beats having a doctor see you and examine you," says Dr. Joseph Heyman, chair of the AMA board of trustees. Joseph Kvedar, founder and director of Partners Center for Connected Health, acknowledges that online second opinions have their limits. "We aren't providing the whole care package," he says. "An online second opinion doesn't replace the caring part of medicine; it's much more technical. That's why we are so keen on having a local partner."

But for the Clarks, who are united in battling Marilyn's rare disease, having choices is what matters most. Their local doctor and the Partners expert agreed that a chemotherapy regimen was a good idea to help battle Marilyn's cancer. Though the two parties agreed on the drugs being used, the online doc recommended waiting until another tumor appeared before starting that regimen. But Vo and Marilyn decided that they wanted to be "aggressive" and went ahead with the local doctor's recommendation. Right now, Marilyn is doing fine. But as they continue their battle with cancer, they will go back online for a "second, third and even fourth opinion," says Vo. "Getting this second opinion and getting hooked up with the best minds in the country makes us feel good. It makes us feel strong." Despite all the technological advances in delivering health care, that may be the best medicine of all.

© 2008