The Value of a Second Opinion at the Mayo Clinic

Goldman, Bruce I Bruce_Goldman at URMC.ROCHESTER.EDU
Sun Apr 9 15:34:54 UTC 2017


Lab accreditation is supposed to assure autopsy quality, but diagnostic accuracy is not a directly evaluated parameter-it is a really important question, especially since the primary responsibility for an autopsy is often given to a trainee.

-----Original Message-----
From: Traian Mihaescu [mailto:traian at MIHAESCU.EU] 
Sent: Friday, April 07, 2017 3:08 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] The Value of a Second Opinion at the Mayo Clinic

"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
https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ispro.ro&d=DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=-7e4riqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuqtJnQTI9F56tW2vYSsx863VpoqEHsQWBArk50&s=JH19pC8Ck33mexsqm9i2BBQPVIguU2vYL2CuhXd2xqY&e= 

> 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://urldefense.proofpoint.com/v2/url?u=https-3A__www.washingtonp
>> ost.com_national_health-2Dscience_20-2Dpercent-2Dof-2Dpatients-2Dwith
>> -2Dserious-2Dconditions-2Dare-2Dfirst-2Dmisdiagnosed-2Dstudy-2Dsays_2
>> 017_04_03_e386982a-2D189f-2D11e7-2D9887-2D1a5314b56a08-5Fstory.html-3
>> Futm-5Fterm-3D.11d4a1346899&d=DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY
>> 53YSKuLUQRxhA&r=-7e4riqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuq
>> tJnQTI9F56tW2vYSsx863VpoqEHsQWBArk50&s=A37cxdq81T3k3BLLvzRBM2uveYtXpG
>> ll56AjR0LJ4Ns&e= > 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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