The Value of a Second Opinion at the Mayo Clinic

Art Papier apapier at VISUALDX.COM
Sun Apr 9 13:58:28 UTC 2017


Agree with Bob!   

I believe the NAS IOM study said that 10% of hospital deaths could be attributed to diagnostic error.  With about 700,000 hospital deaths/yr  that puts the error dx error mortality rate at 70,000 deaths per year

https://www.quora.com/On-average-how-many-people-die-each-day-at-a-US-major-city-hospital

 

There are over 1 billion outpatient visits a year in the US.  If we assume half of these visits are for management or treatment, the other half having a diagnostic question,  and the dx error rate is 10% ( I believe it is higher) that is about 50 million diagnostic errors a year.  

 

So while dx error related deaths are way too high in hospitals, the amount of ambulatory diagnostic error is orders of magnitude larger.  In dermatology, non-life threatening diseases account for a ton of error, result in unnecessary visits, tests, treatments, referrals and costs which patients find really annoying.  Seems trivial, but when you been scratching for a month, and your doc, NP or PA tells you have eczema and you keep putting that steroid cream on as directed, have multiple repeat visits, and then find out after a family member has been diagnoses correctly that you have scabies, you are really upset with your clinician.   These errors erode confidence in medicine and in doctors, they happen daily, and everywhere.  

 

Art Papier MD

CEO VisualDx

Associate Professor of Dermatology and Medical Informatics

University of Rochester

 

From: Bob Swerlick [mailto:rswerli at GMAIL.COM] 
Sent: Sunday, April 09, 2017 8:38 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] The Value of a Second Opinion at the Mayo Clinic

 

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 <mailto: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 <mailto: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 <mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG> > wrote:

 

Just coming out – this  <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> study from the Mayo Clinic 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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