The Value of a Second Opinion at the Mayo Clinic

Bob Swerlick rswerli at GMAIL.COM
Sun Apr 9 23:14:01 UTC 2017


We have a single payer system closer to home, that being the VA health
system. I do not know of any data suggesting that the frequency of
diagnostic error is any better or worse within the VA. I also cannot think
of any reason why a single payer system would be better at diagnostic work.
Perhaps someone who suggested this could provide me with their train of
thought?

Bob Swerlick

On Sun, Apr 9, 2017 at 4:33 PM, Peggy Zuckerman <peggyzuckerman at gmail.com>
wrote:

> 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.ispr
>> o.ro&d=DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxh
>> A&r=-7e4riqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuqtJn
>> QTI9F56tW2vYSsx863VpoqEHsQWBArk50&s=JH19pC8Ck33mexsqm9i2BBQP
>> VIguU2vYL2CuhXd2xqY&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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>> in
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>> >> <Payne et al - 2014 - Patient-initiated second opinions -  Systematic
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>> >> satisfaction.pdf>
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>> Medicine
>>
>> To unsubscribe from the IMPROVEDX list, click the following link:<br>
>> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.
>> exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.im
>> provediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
>> </p>
>>
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/




-- 
Bob Swerlick






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


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