Provider Spotlight: Dr. Mandel, ER Maverick & Locum Tenens Physician

Dr. Ken’s Corner: Second Opinions No Longer an Afterthought

Coming up with the correct diagnosis a hundred percent of the time is not easy. In fact, it’s downright impossible. According to a recent study, more than 20% of patients seeking a second opinion at the Mayo Clinic were found to be misdiagnosed by their primary care provider (Journal of Evaluation in Clinical Practice, April 4, 2017).

Among the patients involved in the Mayo Clinic study, the second opinion diagnosis agreed with the initial primary care provider’s diagnosis only 12% of the time. In 21%, the second diagnosis was “distinctly different” from the first diagnosis. In the remaining cases, the first diagnosis was not completely wrong, but was “better defined” or “refined” by the second opinion.

“Diagnosis is extremely hard,” says Dr. Mark Graber, founder of the Society to Improve Diagnosis in Medicine.  “There are 10,000 diseases and only 200 to 300 symptoms” (Washington Post).  “Doctors are human, and they make the same cognitive mistakes we all make,” says Graber.  “If [a patient] is given a serious diagnosis, or not responding the way [they] should, a second opinion is a very good idea.  Fresh eyes catch mistakes.””

Fortunately, in day-to-day clinical practice, most diagnoses are relatively straight forward — diabetes, hypertension, and asthma, for example.  But, whenever there’s a diagnostic or treatment dilemma, getting a second opinion can be a life saver.

Second opinions are not only beneficial for dealing with a diagnostic dilemma. It can also help allay patient fear and anxiety about a proposed procedure, especially when there’s considerable risk involved. Sometimes a second opinion will help doctor and patient decide between treatment options.  Is surgery the answer, for example, or is a trial of medication more appropriate?

A patient should always feel comfortable asking for a second opinion, for whatever reason, and the doctor’s duty is to encourage and support the process, and not take the request as a personal affront.

A patient doesn’t have to travel to a distant medical center for a second opinion. Qualified local expertise is almost always available in the patient’s own community or one nearby. And now, a number of web-based second opinion sites allow patients to consult with elite medical centers (for a price, sometimes paid for by insurance).

Partners HealthCare, which is affiliated with Harvard Medical School, provides second opinions directly to the physician rather than to the patient.  Harvard’s Dr. Joseph C. Kvedar says doctors shouldn’t worry that Partners HealthCare will “steal” the patient from them. “This is a perfect way for us to provide collegial advice to another colleague, and they’re definitely going to keep the patient,” says Kvedar. “I want to make sure I’m clear: I totally advocate the value of a face-to-face relationship with your doctor” (interview with The Washington Post).

In contrast to the Mayo Clinic study, only 5% of diagnoses were changed by a second opinion from Partners HealthCare, although “90% of the treatment recommendations differed from the primary care physicians’s care plan.”

The web-based second opinion market is becoming increasingly popular with both doctors and patients, with the likes of the Mayo Clinic, Harvard, Cleveland Clinic, and Houston Methodist among those now providing this service.

Whether it’s online or in person, getting a second opinion when indicated is simply good medicine.