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.
Always remember folks, healthcare is business only in it for the money. Doctors offices have turned into drive through chains.
How about a study that looks at all diagnosed illnesses and see what percentage of those are are wrong? Anyone that seeks a second opinion has already found that the original recommended treatment hasn’t worked so of course the percentage would be high. This study, or at least the way it is presented is misleading.
I use lawyers when I am sick.
how is that working out for you?
Medical just denied an MRI for my injured hip and I haven’t been able to walk for over 2 months now. Back to my PCP to let them know. Much suffering ahead. 🙁
It’s called practicing medicine for a reason.
The trouble with studies like this is that there is a selection bias. If you took your kid to one physician who diagnosed an ear infection, chances are the next 20 docs you asked would come to the same conclusion. Second opinions are rarely needed or asked for with typical symptoms of common diseases. I often refer patients for a second opinion when the symptoms are unusual, or don’t fit the typical presentation of any particular illness or disease. The problem in medicine is that there are a limited number of symptoms and a boatload of possible causes. I have been a family doc for over 30 years, and even now, hardly a week goes by that I don’t see something new. The fact that second opinions often result in a different diagnosis does not necessarily mean a doctor is incompetent. it usually means the case is complicated and the cause obscure, or the second opinion would not be asked for in the first place.
The trouble with your profession is that you rely on other people’s research (which is often the drug companies’ research, all of whom have a vested interested in selling you, and hence your patients, their drugs) in lieu of you using your own common sense and experienced-gained knowledge to treat your patients minimally and effectively. Instead, you treat them with drugs, sometimes new and dangerous drugs, of which you know nothing except what the drug company prospectus feeds you with its own biased data.
Other than the surgeons, who practice nuts-and-bolts and fix-the-plumbing type medicine, I have absolutely no respect for your “profession”, having lost a spouse, two siblings and multiple friends (none of which had terminal diseases and instead died due to the drugs they were prescribed or faulty treatment) thanks to your profession’s bungling, lack of knowledge and incompetence. I think it is sad how many people blindly come to the practitioners of your profession with hat in hand thinking that you actually have the answers.
Myself, I haven’t gone to the doctor in years, and chronologically, I’ve outlived all those in my circles who had.
Much of what you say is true. I have become very disillusioned with the current narrative, which is driven by the drug companies. For example, the number of otherwise healthy people who benefit from a flu shot, in an average year, is 1 in 100. that’s called the number needed to treat(NNT). I find that result pathetic. That’s why I don’t urge them on my patients who are healthy. I have brought this up on medical forums, and you would think I eat babies for breakfast by some of the responses I get. Statin therapy for primary prevention has an equally dismal record, as do bisphosphonates for osteoporosis, at least in my opinion. Not everyone buys the party line, Manfred.
The problem with that is that most people who aren’t feeling better after the first treatment prescribed by their doctor don’t go to another doctor for a 2nd opinion. They go back to the original physician. This study only looked at those going to another doctor. I’d be interested to see how many times the SAME doctor got it right the 1st, 2nd or 3rd time.
I’m not sure that is an apples to apples comparison. For example, I am currently looking into a case of extreme fatigue. My first level of evaluation is to look for common causes like hypothyroidism, anemia, and liver or kidney dysfunction. These tests were all normal. Next, I am testing for more unusual etiologies like immune disorders(rheumatoid arthritis, lupus and polymyositis), and considering a diagnosis of exclusion, fibromyalgia. If none of that pans out, I will be testing for Lyme disease and some other oddball stuff. After the initial visit, I contact the patient by phone to discuss the next step. The cost for additional testing is beyond my control, but I don’t make a dime on the time i spend with them subsequently. I don’t think that is quite the same as your mechanic telling you your battery is bad when it turns out to be the alternator.
I have had patients tell me that because the screening colonoscopy they had was normal, that they thought I should pay for it! Only once has a patient called me to thank me for insisting they get a colon exam than discovered an early, treatable cancer. That’s in 30+ years.
If the mechanic billed you for every “test” he decided to run to “rule out” possible problems would you be okay with that?
not sure where you are going with this. how can i find out what is going on without testing? if it costs the mechanic something to do the test, what is your problem? i don’t have one.
With Obamacare deductibles & co-pay prices who can afford to get one diagnosis, much less two? And who can afford the meds & treatments for either, right or wrong?
Since Obamacare, many experienced doctors are retiring. What we are left with is young doctors already burned out with poor bedside manners..
‘88% of the time”?
This isn’t true. BS.
So how many of the second diagnoses are CORRECT?
This doesn’t surprise me at all. Most of the people who I know who were under a doctors care are now dead. I don’t go to the doctor at all and I’m still alive, outliving the oldest by several years. You might reason that all my friends had serious diseases and would have died anyway, but that is not the case. Granted, none were young (all in their fifties and early sixties) but none had a terminal disease and went to their respective doctors for relatively benign complaints.
A bridge too far, Manfred. Your friends went to the doctor and the doctor killed them. Right. I assume all of their relatives successfully sued the nefarious quacks. No? Shocker. However, I am glad you have such an iron constitution. Good for you!
Is the Mayo Clinic assuming its own doctors are 100% correct?
If you follow the link the Mayo press release, 1/2 of the 286 patients in the study had the initial diagnosis made by a nurse practioner or physician’s assistant
Do you think this may have something to do with why our healthcare costs are so high? I work in the service industry. If we don’t fix something right the first time, the customer doesn’t pay us to fix it again. We do it for free. Maybe if we applied that standard to the medical industry we’d see much lower costs.
Our health care costs are high for a multitude of reasons that have little to do with doctors. As a society, we all pay for the services provided to those without insurance, for example. Same thing goes for your car insurance. Drug costs are higher here than anywhere else, because the pharmaceutical lobby owns a lot of pols. Insurance competition is limited and costs for diagnostic testing is not transparent. There are a lot of ways to lower cost, but also a lot of entrenched interests opposing them. When patients present with their diagnosis tattooed on their foreheads, then you can blame me all you like for a misdiagnosis. Till then, I think it unfair to blame those of us on the front line for the failures of those in the rear.
I agree that there is plenty of blame to go around. The insurance companies are a big part of the reason costs are high. However, to say that incompetent doctors (not saying you specifically are) don’t play a role is pretty biased. Ordering tests to “rule out” obscure diseases or just to cover themselves from lawsuits is just as bad as the insurance companies crimes.
i never said that there aren’t incompetent or lazy doctors. i personally order tests to look for what’s a possible cause for my patient’s symptoms. i start with the common, next the unusual, and finally the obscure. what else would you ask me to do?
Also, when doctors DO order tests for CYA reasons, it doesn’t happen in a vacuum. Why don’t you blame the litigious system we have to practice in? That is the root cause of “unnecessary” testing.
“Shared medical decision making”. It all comes down to the providers ability to communicate effectively and educate the patient with what is known/unknown at the time of the “diagnosis”.
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and how many times that different second opinion was wrong?