The Value of a Second Opinion at the Mayo Clinic

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Fri Apr 7 22:04:06 UTC 2017


Curious how one would define a situation where a patient is misdiagnosed
for many months, then a somewhat more accurate diagnosis is found, wildly
different that the first.  That combination of missed/delayed/inappropriate
treatment can create such a level of distrust in the doctor, that any
subsequent recommendation is also distrusted.  Thus, on to another doctor
for a review, or more thorough diagnosis.

It was a situation as above which sent me to the Mayo Clinic to get advice
after a delayed diagnosis, where a 'stomach ulcer' was treated for eight
months, while a kidney tumor grew to 10cm undetected.  When an ultrasound
given to confirm verify a second working diagnosis, "patient's cirrhosis",
per the doctor. However,  the US showed the tumor and a CT scan showed both
a tumor and metastatic disease.  I was NOT told of the metastases, so had
an incomplete diagnosis.

With that, I went to Mayo, self-referred,  not trusting the former doctor
to recommend the proper specialist.  Though I knew I had kidney cancer
heading into Mayo, I did not know that it was metastatic kidney cancer.

With what I know now, I could argue that until the type of kidney cancer is
found by pathology and/or genomic testing, the diagnosis was still
incomplete.

Since this kind of situation is likely very common as patients finally
reach a meaningful diagnosis, it is critical to assess how common this is
and then to determine how to prevent these situations.

Peggy Z


Peggy Zuckerman
www.peggyRCC.com

On Fri, Apr 7, 2017 at 12:08 PM, Traian Mihaescu <traian at mihaescu.eu> wrote:

> "An autopsy can reveal clinically significant diagnoses missed before
> death"..but, are there any data about diagnostic errors in autopsy
> studies?
>
> Traian Mihaescu, MD
> Clinic of Pulmonary Diseases
> Iasi, Romania
> www.ispro.ro
>
> > 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>
> >>
> >>
> >>
> >> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> >> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> >>
> >> To unsubscribe from IMPROVEDX: click the following link:
> >> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
> >> <http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1>
> >>
> >> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> >> <mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>
> >>
> >> Visit the searchable archives or adjust your subscription at:
> >> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> >> <http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX>
> >>
> >>
> >> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> >> Medicine
> >>
> >> To learn more about SIDM visit:
> >> http://www.improvediagnosis.org/ <http://www.improvediagnosis.org/>
> >>
> >>
> >>
> >>
> >> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> >> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> >>
> >> To unsubscribe from IMPROVEDX: click the following link:
> >> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
> >> <http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1>
> >>
> >> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> >> <mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>
> >>
> >> Visit the searchable archives or adjust your subscription at:
> >> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> >> <http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX>
> >>
> >>
> >> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> >> Medicine
> >>
> >> To learn more about SIDM visit:
> >> http://www.improvediagnosis.org/ <http://www.improvediagnosis.org/>
> >>
> >> <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
> >
> > To unsubscribe from the IMPROVEDX list, click the following link:<br>
> > <a
> > href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=
> IMPROVEDX&A=1"
> > target="_blank">http://list.improvediagnosis.org/scripts/
> wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
> > </p>
> >
>
>
>
>
>
>
> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in
> Medicine
>
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=
> IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/
> wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
> </p>
>






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


HTML Version:
URL: <../attachments/20170407/e8d8057d/attachment.html>


More information about the Test mailing list