The Value of a Second Opinion at the Mayo Clinic

Bob Swerlick rswerli at GMAIL.COM
Sun Apr 9 12:38:12 UTC 2017


This is a perfect example of selection bias. You need to be dead to undergo
an autopsy. How applicable is this to the realm of the misdiagnosed but not
dead? I agree that autopsies are likely to be useful in the highest stakes
environments but what percentage of misdiagnoses leads to death? I realize
this is basically a rhetorical question since no one really can have this
answer. I just have to wonder how generalizable will autopsy findings be to
the broader population of patients who are misdiagnosed and do not die?

Bob Swerlick

On Sat, Apr 8, 2017 at 6:24 PM, Joe Graedon <jgraedon at gmail.com> wrote:

> I encourage everyone to go back and read George Lundberg's thoughtful
> article "Low-Tech Autopsies in the Era of High-Tech Medicine: Continued
> Value for Quality Assurance and Patient Safety." George was editor-in-chief
> of JAMA at the time. That was 1998.
>
> George pointed out that since the 1930s approximately 40% of the time the
> diagnosis that was made before death was different from that revealed by
> autopsy.
>
> A NYT article from 2006 noted that "studies of autopsies have shown that
> doctors seriously misdiagnose fatal illnesses about 20 percent of the
> time..."
>
> I find it interesting that autopsies have pretty much gone the way of the
> buggy whip...but the 20% figure (see the recent Mayo study on 2nd opinion)
> resurfaces.
>
> When will patients and their families be included in this process in a
> meaningful way and when will modern medicine embrace Larry Weed's vision?
>
> Will a new generation of health professionals still be having this
> conversation 60 years from now?
>
> Joe
>
> Sent from my iPad
>
> On Apr 5, 2017, at 3:49 AM, Bridget Kane <kaneb at TCD.IE> wrote:
>
> One of the questions for me is β€œare 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>
> 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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-- 
Bob Swerlick






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


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