05 May 2017

Medical Second Opinions

Welcome back. I’ve been lucky. Over the years, I’ve had only one medical issue whose solution was uncertain enough to seek a second opinion. According to the National Academies’ 2015 report, Improving Diagnosis in Health Care, diagnostic errors--inaccurate or delayed diagnoses--persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.

Getting a second opinion
(multiple websites)
That report identifies four types of information collection in the diagnostic process: obtaining the clinical history and interview, a physical exam, diagnostic testing and sending a patient for referrals or consultations. Regarding the last, while patients can obtain a second opinion on their own, as I did, clinicians may refer to or consult with other clinicians for additional expertise to help confirm or reject their working diagnosis or provide information on treatment options.

Second opinions didn’t come to the forefront for me because I or a family member or acquaintance have an ambiguous, uncertain or undiagnosed medical problem. It’s only because I came upon a recent study that provided some rather eye-popping metrics on the value of second opinions. I thought you might be interested.

Diagnostic Agreement With Referrals
To get a measure of how frequently final diagnoses vary and change the direction of medical care, researchers from the Mayo Clinic conducted a retrospective analysis of the records of 286 patients. The patients had been referred to the clinic by physicians, physician assistants and nurse practitioners from primary care practices in the years 2009 and 2010.

Comparing the referral diagnoses with the clinic’s final diagnoses, the researchers found the diagnoses agreed in only 12% of the cases. The final diagnoses were distinctly different than the referral diagnoses in 21% of the cases, and the final diagnoses were better defined or refined in 66% of the cases. There were no real differences associated with the types of provider making the referral.

Wrap Up
Because health care cannot be separated from cost, the researchers tallied the costs for the second opinion, including the referral visit and services within the first 30 days. As would be expected, the total costs for cases when the final and referral diagnoses differ were significantly higher than the costs for cases of either the confirmed or refined diagnoses.

The study findings emphasize the importance of the National Academies’ effort to improve medical diagnoses. Getting it right without delay can be a matter of living or dying. Correct diagnoses become all the more important when referrals may be limited by insurance.

Fortunately, Congress is on top of the problem and we’ll soon be able to relax. I’ve heard it’s gonna’ be great. Thanks for stopping by.

National Academies report: www.nap.edu/catalog/21794/improving-diagnosis-in-health-care
Mayo Clinic study in Journal of Evaluation in Clinical Practice: onlinelibrary.wiley.com/doi/10.1111/jep.12747/full
Article on Mayo Clinic study on ScienceDaily website: www.sciencedaily.com/releases/2017/04/170404084442.htm

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