ROCHESTER, Minn. — When it comes to treating a serious illness, two brains are better than one. A new study finds that nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told.
Researchers at the Mayo Clinic examined 286 patient records of individuals who had decided to consult a second opinion, hoping to determine whether being referred to a second specialist impacted one’s likelihood of receiving an accurate diagnosis.
The study, conducted using records of patients referred to the Mayo Clinic’s General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time.
Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.
“Effective and efficient treatment depends on the right diagnosis,” says lead researcher Dr. James Naessens in a Mayo news release. “Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling ─ not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all.”
Considering how health insurance companies often limit the ability of patients to visit multiple specialists, this figure could be seen as troubling.
Combine this with the fact that primary care physicians are often overly-confident in their diagnoses, not to mention how a high number of patients feel amiss about questioning their diagnoses, a massive issue is revealed.
“Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care,” says Naessens. “Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnosis, resulting in treatment delays and complications, and leading to more costly treatments.”
The researchers acknowledged that receiving a completely different diagnosis could result in a patient facing otherwise unexpected expenditures, “but the alternative could be deadly.”
According to the release, The National Academy of Medicine cites diagnostic error as an important component in determining the quality of health care in its new publication, Improving Diagnosis in Health Care:
Despite the pervasiveness of diagnostic errors and the risk for serious patient harm, diagnostic errors have been largely unappreciated within the quality and patient safety movements in health care. Without a dedicated focus on improving diagnosis, these errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity.
The study was published in the Journal of Evaluation in Clinical Practice.
Both my good friend (advanced lymphoma) and my mother (mesothelioma) were misdiagnosed by Mayo Clinic where in both second opinions the specialists said there was no reason for both not to have been easily identified. My advice is if you have received a diagnosis from Mayo get a second opinion.
It depends on which Mayo Clinic. Rochester is still the Prime. The other campuses are getting like all the other Med. Facilities – Carrying a name only – not the best in Doctors. Emory is now all over Atlanta now. Physicians buy into the Corp. of the name because of prior quality. Now, it’s all getting to be the same!
A foster brother of mine had been diagnosed with ring worm at the Mayo Clinic.
After he was adopted to a doctors family, they quickly figured out it was psoriasis.
Referrals are usually made when symptoms might indicate something more serious, or when a surgical procedure is suggested. Primary care physicians are not all the fabled Hollywood Dr. Gillespie – the Sherlock Holmes of physicians. A significant part of their job is referral to specialists. Thus, refinements in diagnosis or discovery of something more serious is both common and appropriate. This study merely stipulates that a divergent diagnosis came from specialists. This “record review” does not validate the diagnosis of either physician.
Perhaps not, but when you couple it with studies that show that a Dr. has generally reached a conclusion in the first minute or so, it’s troubling. I know many people that have had to diagnose themselves. One with a very serious blood clot issue and another that simply had a case of the mumps. There are many others and I’m sure everybody has stories like that. Many Dr.’s are unwilling to be questioned, don’t want to explore other avenues and many don’t keep up. That’s why when you find a good one you have to hold on for dear life and hope they don’t get fed up with the profession.
When a Physician only has 15 min. to diagnose – How can they really listen, type up on the computer and really examine??
stop overscheduling…take some time with the PATIENT rather than playing on your laptop..
Obamacare forces physicians to use a computer dummy. You want more time with the doc but don’t want to pay for it.
Doctor’s aren’t allowed to spend more time with their patients and are forced by Medicare/Medicaid reimbursement rates and by pressure from administrative types to spend only 20 minutes on a patient unless they are a new patient (then 45 minutes). That includes MAs or nurses taking vitals and patient information, diagnosis, and deciding how to treat. No time for chitchat.
I am a retired health scientist, and I always check webMD, MayoClinic, etc. on the web before seeing my physician. I want to know what I might have so I ask relevant questions. I guess it all hinges on how involved you want to be in your own healthcare.
An anesthesiologist friend at work told me about the concierge medical practice he used. You pay an annual retainer fee of $1600 to $2000, which includes a 1st-class annual physical. Your insurance still pays for visits, tests, and treatments as usual. But a typical visits runs 20-30 minutes with lots of discussion. You doctor enters the examining room prepared with all the notes, x-rays, lab tests etc., and you go through them item-by-item. When you call, you are seen in under 24 hours – right away if an emergency.
Of course, many people cannot rationalize that extra retainer cost. I put it off for 5 years. However, when my primary care doc and I disagreed twice about my diagnoses – and tests proved him to be wrong both times – I decided my healthcare was worth at least the price of an annual membership in a gym or tennis club.
webMD has too many opinions not always confirmed by facts. Mayo has better quality studies and information. The NIH database is very exhaustive, but it takes time to learn.
In several cases the NIH database saved a lot. In one case when admitted to the emergency room of one of the highest rated hospitals in the Washington DC area. the nurse came into the room with two bags to start an IV they were going to start on one arm. I stopped her asking, what was in each bag, one was magnesium, so I asked if the two were compatible. Oh we have used this combination for years was her answer. I demanded she check with the hospital pharamcy for compatibility. Response for each with each other was variable and variable. They wanted to continue but I insisted they find find out what variable was saying. They contacted the supplier and discovered that the two used at the same time was fine if each was on their own IV tap (one left side and one right side). But when both are on the same arm their is s documented risk of colagulation, the process of the blood turning from a liguid into a gel.
There were two other questions during the diagnostic process they couldn’t give me a correct answer to, so I kept researching and asking questions.
Want to live longer assume nothing and demand answers to reduce risks. Have a computer to use and keep going to the medical databases with the best research studies.
Good for you. I do the same.
not everyone HAS those resources.
How would one find a concierge medical practice. I am interested.
There are scads of websites that review the pros and cons (the latter usually being cost). Use Google or otherwise search using the terms “concierge medicine.” In most web browsers, if you type those words into the address bar, it will search. Your best approach to finding a concierge practice near you is to add your zip code as a 3rd search term. It is even possible that your current doctor offers concierge service. Here are two websites for large concierge medical practice networks that have doctors in multiple states: http://www.signaturemd.com (with whom my doc is affiliated) and http://www.choice.md. Good luck!
Thank you.
another time, My then PC dr “missed” diagnosing shingles as muscle pain. It was only after two further days of pain in the neck that an ER Dr called it right.
Same here, after missing the shingles in the emergency room and a follow up with my GP, my grandmother diagnosed it within 5 seconds of looking at my rash.
As an orthopedic surgeon I’ve had many patients come to me singing the praise of another md that I know to be incompetent and others to disparage mds that I know to be best in their field.Treating patients and pleasing patients are two different goals and often have very little in common.Just because you like or agree with your doctor doesn’t mean they are correct.
But will you admit this to the patient/public. Most doctors around here, Louisiana, cover for each other to the point of abetting malpractice. One hand washes the other to keep from getting sued.
When I refer patients to other specialist I refer only to physicians that I would personally use.Most physicians come from the top 10% of their college class.They may not be great doctors but they are smarter than most other professions.No one is perfect and to be quiet honest 50% of what we think is correct now will be proven wrong in 50 years.This idea that we conspire to keep pts in the dark is ridiculous.
Most problems are of such a nature that a competent, experienced clinician can make an accurate diagnosis quickly. Everything from your skin tone to how you walk provides clues to your condition. Plus in most cases, by the time you see the doc, his nurse has talked to you and gathered preliminary information that the doc has looked at. I’m not bothered by *most* diagnoses being made in a minute or so. Now if a doctor does that all the time I would be concerned, but most cases do not require more time.
When will they start to report how many people died waiting 2 hours in the Doctor’s waiting room. I wonder how many had false “High Blood Pressure” readings because of the frustration of waiting???
I once waited 12 hrs in ST Mary’s emergency room for antibiotics and an albuteral treatment bc my PC “missed” the pneuomonia diagnosis, even though I directly queried abt it to him at the initial visit..Ps I had to INSIST on the albuteral treatment there as well.
Stethoscope in the ears of a trained physician, chest x-ray, CT scan if indicated, oxygen saturation levels, and serology all belong in the toolkit enabling conclusive diagnosis of pneumonia.
“albuteral [sic]” doesn’t diagnose anything. Albuterol is a bronchodilator which relaxes airway muscles and thereby improves lung airflow. The correct antibiotics can cure episodes of pneumonia.
The antibiotics were worth the wait; although otherwise health folks almost certainly contract and recover from pneumonia all the time, and without medication or other treatment in ‘medical’ settings.
My BP spikes when dealing with some nurse aids
My bp is allways higher at the clinic. lol
I will offer another perspective for you; primary care physicians are also often mislead by the very referrals and tests they order, particularly radiology. So much of medicine now days relies on medical imaging for accurate diagnoses. Many people erroneously assume this is a black box test like your lab work; however, this is reliant on very highly trained radiologists making judgement calls in a very difficult field of medicine. The quality is NOT the same!! Studies have been published before showing similar findings..the same imaging study interpreted by radiologists at a higher caliber medical institution led to a significant change in diagnosis in about 80%. Any primary or specialty physician relying on this inaccurate diagnosis is crippled. This is important because we see now this idea of “shopping around” for imaging studies because prices differ, but remember, you are also paying a physician to interpret those images and you get what you pay for! At our tertiary care facility, we often see patients get their imaging done somewhere else because it is “more convenient” but the quality of the study is often very poor and the interpretations far too often inaccurate. You may also find that in cost saving measures or just to maximize profit, imaging centers often ship images to be read overseas for a very low price by physicians in India or such. You should always be weary and question who is actually reading the imaging studies you are getting, what are their credentials, and what is their training. You wil also see a drastic difference in performance when comparing “general” radiologists to specialty trained, like Neuroradiology or Pediatric Radiology.
Assuming your primary is not discouraged from making referrals by the insurance company (i.e. more pay for less referrals).
Who expects their insurance to pay for everything? I do not want insurance companies driving my and my doctor’s treatment decisions.
Imagine hearing: “My doctor said it might be cancerous, but BlueXYZ won’t pay for a referral to a specialist to find out for sure. I feel fine. It’s probably not cancer…”
These are same people who hear from a specialist two years later: “The tests shows it is malignant. There is little we can do at this stage. Had we caught it earlier the odds of recovery would have been high, but…..”
My kid lost some of his hearing due to his doctor’s reticence towards an ENT referral (always just prescribing antibiotics). Found out later that there was a monetary incentive to not do referrals. Finally we forced the issue but it was too late and, even though he got tubes within 2 weeks, the damage was done. This was 20 years ago and I’m still pissed.
This may be the case at Mayo Clinic, but in the world of industrial, impersonal medicine, one doctor after another will sign onto the original diagnosis and continue to treat the wrong illness. This how a patient can go from doctor to doctor over a course of years and not get better untill a fresh investigation and diagnosis is made.
It all depends on the institution you’re dealing with and if you can get your doctor’s notes (by law you should be able to but many institutions say err??)( speaking of that, you would be surprised who within any institution has access to your medical records).
Anyway, my brother has almost been killed twice, both times by a primary who never should have become one. He took a look at a spot on his leg and said nothing but ya ok go see a derm so they made a 3 month appt, turned out to be the worst which the derm identified immediately. Primary should have made an immediate appt. Second time a urologist finds an induration on his prostate, puts the note in his file to follow up, does not mention it nor follow up, at the same time his primary is afraid to do prostate exams so 6 years later full blown cancer, high gleason and removal. AND all this is from a {cough cough} allegedly famous and reputable institution.
Every nurse I have ever spoken with has repeatedly said “Get a medical advocate or become a medical advocate for yourself, take the time to learn or pay someone to do it for you, period, because they all make mistakes”.
It appears new Drs these days are trained to fill out a PRESCRIPTION and not much else………unless one gets lucky enough to have a Dr that was trained in South Africa. These Drs are great.
You have to remember that most doctors won’t overrule another doctor as professional courtesy. They won’t testify against each other, and damn sure will not say another did something wrong. Morbidity and Mortality class in medical school is nothing but a class on how to cover up mistakes under the guise of “Learning”. That class is where you learn to “find” causes other than malpractice or mistakes.
It’s worse than I thought
You have no idea what you are talking about. “Morbidity and Mortality class in medical school” does not exist. Morbidity and Mortality conferences are held in residency, and are for the purpose of reviewing cases with unexpected complications or deaths. It sounds to me like you should apply to Medical School and become a doctor. Then you can set things straight and correct all the errors that are being made.
You are not obligated to say to another doctor that you need second, third or other opinion. What country do you all live? What doctors do you choose? Your health is your obligation. Do your homework.
“…untill(sic) a fresh investigation and diagnosis is made.” By a doctor?
I have the sense that A.I. Diagnosis may function under some of the same assumptions – always go to the obvious. I have no quarrel with doctors, most of them. I do resent being treated like a widget on an assembly line in a doctor’s office.
For several years I struggled with a rib pain that would not go away and sought opinions from several doctors in several states who each had a different diagnosis. Several thousands if not tens of thousands in tests, bone scans, CT scans, even cardiac scans it appeared I had not choice but surgery to try and figure out the issue. My regular doctor was away and a mostly retired doctor was filling in for him when I showed up to get treated for a sinus infection. He noted that I had been seen for the other pain and told me…you realize this pain will go away after a couple of weeks if you would not carry stuff against that side of your ribs and used the other side instead? It did…it was something called rib tip syndrome that is very common and I have not had the pain since.
I had rib tips for dinner at the diner…it was the daily special.
Could there be a phenomenon taking place where the very act of fishing for a second diagnosis, because the first one is not to ones liking, is subconsciously subtly influencing the second opinion makers diagnosis. After all if the initial diagnosis is as dire as is usually the case when seeking a second opinion what does the second opinion have to lose by offering long shot hope with a more radical course of treatment. As far as the 20% TOTAL misdiagnosis conclusion reached by the 2nd physician it doesn’t necessarily mean it’s a given that the initial diagnosis is incorrect. Of course the second opinion has the advantage of working off the initial diagnosis by looking for errors where if they had been the the first physician they might have come to the same initial conclusion. My Rx is don’t get sick and good luck.
If a patient’s diagnosis being not to their liking can subconsciously influence a second opinion makers diagnosis then you are right, they are opinion makers. Posers of science.
What about pets?
What about pets? Please elaborate.
I may be on the wrong track here, but I believe he may be talking about the diagnosis of veterinarians, regarding illnesses with people’s pets. Perhaps that they too give different opinions. Just my guess.
Of course, come to think of it…. I could be completely wrong….in which case we may need to get a second opinion 😉
I thought my comment was self evident. Thanks for expanding it for those who need it.
I guess it wasn’t self evident, because I had to ask.
I thought it was along those lines, but given the topic, I felt it best not to jump to conclusions. I do appreciate you confirming the diagnosis 😉
Great reply! Thanks.
😉
Who Cares!
Gee, you must have better things to do than make such insightful comments. Get out of here! Gloria would be proud.
I tell ya, I don’t get no respect. I went to see my psychiatrist…he told me I was stupid. I said I want a second opinion. He said, okay, you’re ugly too. – Rodney Dangerfield.
Love it!
I miss Rodney. Great comedian.
Ha, ha, but how sad. That is why doctors call their business a “practice”. That is what doctors do, they just practice on you.
Last summer, US Health Care industry admitted it was No.3 cause of death in USA, due to “mistakes”. But, the No. 3 rating only included hospitals, and did not include doctor’s offices and clinics, which is where most of the damages occur. If we include all doctor’s “practices” they become No. 1, 2, and 3 cause of death. MDs are quacks who follow destructive Rockefeller medicine, they are big pharma’s kill teams sent to destroy lives. Properly prescribed “prescription” drugs kill over 200,000 Americans every year. If you sold a product like this you’d be in prison for life.
Stay away from MDs, they are emergency medicine only, to be used for emergencies like car accidents, gunshots, illegal wars, etc. You’re much better off doctoring yourself for common ailments using products like colloidal silver, or even oregano oil and turmeric. I like Advanced Silver Company, but all 10ppm solutions work great, and silver kills fungus, bacteria, and stops viruses. Big pharma has same silver, but they prefer to sell you something patented, even if they create deadly superbugs. Its just more business for pharma when they do.
Can you imagine what medicine will be like in 5 years when all of the SJW snowflakes graduate from medical school and are unleashed on the world.
Yeah, tell that to Steve Jobs. BTW, who exactly is “US Health industry” that admitted to this? Where can one find them? Also, colloidal river only works if you wear a chin strap and a feather on your tin-foil hat.
I use raw garlic. It probably has similar effects – anti-bacterial, anti-viral, anti-fungal, anti-parasitic. The universe of natural remedies is as wide as planet earth. The universe of main-stream medical remedies is as narrow as a cash register.
Likewise. I thought his brand of self-deprecating humor was brilliant. He was an absolute master at getting all of the key elements put in place in just a few words, and then delivering a funny punch line. He made it look easy. The good ones always do.
That’s why we need to replace most doctors with robots……or H1N monkeys that program robots.
It seems to me that it would be in the interest of insurers to have a second diagnosis. Mistreatment or non treatment of an illness/injury could result in higher overall costs to the insurer than the cost of a second specialist opinion.
My insurance company pays for second opinions. I guess they hope the second opinion will cost less to treat then the first opinion.
I suspect many doctors will want a second opinion (i.e., a second study) about about this study.
isnt it reassuring- NOT wayne- to know that any 2 doctors agree on the self-same issue as your life and death diagnosis only 12% of the time- that’s nutzoid as its life and death in so many instances and only shows your hard earned healthscare funds are being wasted up the yingyang (theirs) because there’s no rhyme or reason to the professional opinion of one verses 2-3-4 or niore mired in bloody muddy doctors witch (sorry my spelling is off) only 12% way medicine like voodoo witch magic is being practiced these paydays (theirs) only 12%.in the good ole us of a thanks for nothing obama