The Value of a Second Opinion at the Mayo Clinic

Burke Harry harry.burke at GMAIL.COM
Wed Apr 5 18:30:15 UTC 2017


The gold standard used to be autopsy. Unfortunately, the rate too low to be of much use today.

Harry B. Burke, MD, PhD

Chief, Section of Safety and Quality


Associate Professor of Medicine

Department of Medicine

F. Edward Hébert School of Medicine

Uniformed Services University of the Health Sciences


> On Apr 5, 2017, at 12:45 PM, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG> wrote:
> 
> 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 <mailto:kaneb at tcd.ie>>
> Date: Wednesday, April 5, 2017 at 12:49 AM
> To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "mark.graber at improvediagnosis.org <mailto:mark.graber at improvediagnosis.org>" <Mark.Graber at Improvediagnosis.org <mailto: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
> <image001.png>
>  
>  
> 
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> <Payne et al - 2014 - Patient-initiated second opinions -  Systematic reivew of characteristics and impact on diagnosis, treatment, and satisfaction.pdf>







Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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