The Value of a Second Opinion at the Mayo Clinic

pday daynurse at GMAIL.COM
Sat Apr 8 20:20:47 UTC 2017


Observationally, I estimate it takes 10 trips to the doctor to get an
accurate diagnosis of zebras. "When you hear hoofbeats, think horses, not
zebras," was the meme when I practiced nursing.
My personal experience with Mayo was that it was a waste of travel money
and time and lead to years of needless suffering. My accurate diagnosis
came 7 years after that Mayo visit. Back then, I told the doctor my
suspicions and they were later proven to be correct.
Peggy (another one) Day

On Sat, Apr 8, 2017 at 4:06 AM, Vic Nicholls <nichollsvi2 at gmail.com> wrote:

> In addition to Peggy's issue below, I have also encountered the inability
> or refusal to treat issues. Muscle problems can be caused by calcium and
> dehydration issues. However, neurologists refuse to treat that. They are
> certainly able to prescribe calcium/Vitamin D, fluids, and it seems odd
> that they can't.
>
> We need to ascertain why treatment is refused and what medical basis there
> is for that. I can't find any in the medical research.
>
> Vic
>
>
>
> On 4/7/2017 6:04 PM, Peggy Zuckerman wrote:
>
> 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-misdia
>> gnosed-study-says/2017/04/03/e386982a-189f-11e7-9887-1a5314
>> b56a08_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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>> in
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>> >>
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>> in
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>> >>
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>> >>
>> >> <Payne et al - 2014 - Patient-initiated second opinions -  Systematic
>> >> reivew of characteristics and impact on diagnosis, treatment, and
>> >> satisfaction.pdf>
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>>
>>
>>
>>
>>
>>
>> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in
>> Medicine
>>
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>
>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
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>
>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
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> http://www.improvediagnosis.org/






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


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