The Value of a Second Opinion at the Mayo Clinic

Mark Graber Mark.Graber at IMPROVEDIAGNOSIS.ORG
Wed Apr 5 16:45:23 UTC 2017


Thanks Bridget for this KEY question.  There are indeed a few studies that have done longer-term follow up of patients to determine whether the second opinion was correct (referenced in the attached review article) and you won’t be surprised to know that in a fraction of these cases (around 10%) the original diagnosis was correct, or even something not yet considered.  These long-term follow-up studies are difficult to conduct but very valuable.

Your comments also touch on another big problem in our field – what is the gold standard?  There is a great deal of uncertainty even at this level, given that biopsy and autopsy results are not always definitive.

Mark

Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University





From: Bridget Kane <kaneb at tcd.ie>
Date: Wednesday, April 5, 2017 at 12:49 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "mark.graber at improvediagnosis.org" <Mark.Graber at Improvediagnosis.org>
Subject: Re: [IMPROVEDX] The Value of a Second Opinion at the Mayo Clinic

One of the questions for me is “are we assuming that the second opinion is the gold standard?”
Or how can we identify the truth, i.e. the correct diagnosis?

Is there a stronger placebo effect following a second opinion, I wonder?

Does anyone have any research on this, by chance?

Thanks

Bridget
On 4 Apr 2017, at 16:02, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG<mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG>> wrote:

Just coming out – this study from the Mayo Clinic<https://www.washingtonpost.com/national/health-science/20-percent-of-patients-with-serious-conditions-are-first-misdiagnosed-study-says/2017/04/03/e386982a-189f-11e7-9887-1a5314b56a08_story.html?utm_term=.11d4a1346899> finds that 20% of referred patients end up with a very different diagnosis.  The findings are very similar to the results from the second opinion program at Best Doctors, as referenced in the Mayo Clinic article.  In both cases, however, these are not randomly selected patients being studied – they are patients who were concerned enough about their initial diagnosis (or lack thereof) to seek out the second opinion.

Mark

Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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