Do first opinions affect second opinions?

Background: Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians.

Objective: To evaluate whether physicians' judgment is affected by another medical opinion given to a patient.

Design: Orthopedic surgeons and neurologists filled out questionnaires presenting eight hypothetical clinical scenarios with suggested treatments.

Adherence by primary care physicians to guidelines for the clinical management of dyslipidemia.

Background: There is a wide treatment gap between evidence-based guidelines and their implementation in primary care.

Objective: To evaluate the extent to which physicians "literally" follow guidelines for secondary prevention of dyslipidemia and the extent to which they practice "substitute" therapeutic measures.

Methods: We performed a post hoc analysis of data collected in a prospective cluster randomized trial.

[Second medical opinions].

Second opinion is a decision-support tool for ratification or modification of a suggested treatment, by another physician. Second opinion may have a critical influence on the diagnosis, treatment and prognosis. The patient can benefit from treatment optimization and avoid unnecessary risks.

Physician adherence to the dyslipidemia guidelines is as challenging an issue as patient adherence.

Background: A wide therapeutic gap exists between evidence-based guidelines and their practice in the primary care, which is primarily attributed to physician and patient adherence.

Objective: This study aims to differentiate physician and patient adherence to dyslipidemia secondary prevention guidelines and various factors affecting it.

Methods: A post hoc analysis of data collected by a prospective cluster randomized trial with 7041 patients diagnosed with clinical atherosclerosis requiring secondary prevention of dyslipidemia and 127 primary care physicians over an 18-month period.

Factors affecting physicians compliance with enrollment suggestions into a clinical reminders intervention.

Clinical reminders can promote adherence with evidence-based clinical guidelines, but they may also have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. The described clinical reminder system identifies patients eligible for primary prevention of cardiovascular diseases and lets the physician to choose which patients will be included in the reminders intervention. We analyzed data of 87,165 visits of 35,699 patients and evaluated factors which may affect clinicians' decision to enroll patients to the intervention.

Defining and measuring physicians' responses to clinical reminders.

Decision-support systems, and specifically rule-based clinical reminders, are becoming common in medical practice. Despite their potential to improve clinical outcomes, physicians do not always use information from these systems. Concepts from the cognitive engineering literature on users' responses to warning systems may help to define physicians' responses to reminders.

General practitioners' adherence with clinical reminders for secondary prevention of dyslipidemia.

A variety of computer-based applications, including computerized clinical reminders, are intended to increase adherence to evidence-based clinical guidelines. The value of these systems in clinical practice is still unclear. One reason for the limited success of clinical reminders may be physicians' low tendency to adhere to their advice.