The Value of a Second Opinion at the Mayo Clinic

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Sun Apr 9 20:33:45 UTC 2017


Re the question if a country with a single-payer system automatically
grants patients better care and better outcomes, the real question to be
posed is what measures are used to do so.

In my kidney cancer world which encompasses many patients in the US, Canada
and the UK, I know of many errors in diagnosis in each of them.  Much of
those errors derive from the simple lack of expertise by a mix of doctors.
Primary care docs don't consider the symptoms which can be reported over a
long period of time, whether serious back aches (flank pain is classic
symptom--but what patient uses the term "flank pain"?), anemia, or
unexplained weight loss. Urologists who may operate to remove a tumor often
do not complete the diagnosis with CTs and /or bone scans, and reassure the
patient, "I got it all", yet they do not search out the non-localized
metastases.  When that patient finally is sent to an oncologist, if ever,
the oncologist may not have any idea of what to do, and may simply apply
the 25 year old treatment--nothing--or use the latest newly approved drug,
but with little understanding of the disease and those treatments.

All of these mistakes happen in all three of these countries.  In Canada,
the province in which one lives makes a difference as to the medicines
and/ior specialists available. Similar in the UK, with Scotland having far
higher death rates from cancer.  The measures of treatment for diagnosed
cancer patients is mandated to start at 31 days.  Yet extending out tests
which diagnose, including those which should have been done simultaneously
gives a reset of the clock.  So treatment does not begin in 31 days, but 31
days after 90 days of delayed testing.

Peggy z

Peggy Zuckerman
www.peggyRCC.com

On Sun, Apr 9, 2017 at 8:34 AM, Goldman, Bruce I <
Bruce_Goldman at urmc.rochester.edu> wrote:

> 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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> >> <Payne et al - 2014 - Patient-initiated second opinions -  Systematic
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> >> satisfaction.pdf>
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