Monday, Apr 23, 2018
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Get a second opinion

Roll a die. Then roll another one. They’ll come up the same one out of six times.

Go to a primary care provider. Ask the Mayo Clinic for a second opinion. The diagnoses will be the same one out of eight times.

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That result from a new study doesn’t mean doctors are less reliable than dice. After all, the study only considered diagnoses that were taken to the Mayo Clinic, which most cases aren’t. These are likely to be complex, unusual, and high-stakes cases. The primary care physicians, physician assistants, and nurse practitioners who referred their patients to Mayo may have doubted their own diagnoses. Presumably, if every diagnosis were double-checked, many more would be confirmed.

Still, it’s a dramatic finding. And it’s only part of the picture. More than one in five times, the original diagnosis was thrown out altogether. About two-thirds of patients received what a clinic statement called “a refined or redefined diagnosis.”

The study brings home how difficult it is for doctors to figure out what’s wrong with a patient. A researcher not part of the study team told the Washington Post: “There are 10,000 diseases and only 200 to 300 symptoms.”

Yet a doctor who doesn’t know the real cause of a patient’s problems may provide treatment for the wrong condition. The study cites research showing that about 1 in 10 times a patient dies, a faulty diagnosis played a part.

So getting the right diagnosis when something serious is, or even may be, going on is vital. And it would be unwise to be too confident that the first doctor who takes a look at a problem is going to get it right.

That means patients who may be seriously ill should get second opinions even if their doctors don’t suggest it.

Those opinions should come from specialists. Indeed, if the possible causes of the same symptom lie in multiple specialties — chest pain, for example, might come from the lungs, the heart, or elsewhere — asking multiple specialists might be wise. Granted, there are costs to such precautions. But the costs of getting the right diagnosis too late may be much steeper.

Ultimately, it’s the patient’s health at stake, and that means it’s the patient’s responsibility to make sure the doctors are treating the right problem.

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