Whether or not to get a second opinion is a common question among patients across the U.S. Diagnostic ambiguity is widespread in healthcare, making referrals an important means for patients to learn more about their condition and treatment options.
However, as recent data suggest, a second opinion may be necessary in more cases than we think – because the first is almost always incomplete or just plain wrong.
The Surprisingly High Rate of Misinformation
In a new study, Mayo Clinic compared the referral and final diagnoses of 286 patients referred to 1 of the institute’s medical centers. Researchers sorted their findings into 3 categories: the same referral and final diagnosis, a better or more refined referral diagnosis, or distinct differences between the 2.
In only 12 percent of cases, the referral diagnosis was the same as the final, and in 66 percent of cases, it was better. But to a startling 21 percent of patients, the medical center gave a completely different diagnosis than the original.
The study also looked at the costs of each referral visit and subsequent services performed at the medical center in the first month. In category 3, the costs were significantly higher.
As 1 of the best research organizations in the country, Mayo Clinic is known to attract referrals with health concerns that are difficult to diagnose. But without the right diagnosis, patients cannot hope for the best outcome.
“Effective and efficient treatment depends on the right diagnosis,” said Dr. James Naessens the study lead and health care policy researcher at Mayo Clinic. “Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling ─ not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all.”
Diagnostic Error a Trivialized Killer
The study concluded that inconsistencies between diagnoses can result in delays or complications in treatment that lead to costlier services down the line. But incorrect diagnoses don’t just have financial consequences for hospitals. For patients, misdiagnosis can lead to false hope, the wrong treatment, or even death.
A BMJ Quality & Safety study revealed that as many as 12 million – or 1 in 20 – U.S. adults are misdiagnosed every year. About half of these errors have the potential to cause severe harm or injury, or they could possibly lead to death.
The study went on to detail seemingly harmless symptoms that often lead to misdiagnoses, including a cough, abdominal pain, and shortness of breath – symptoms that can mark the first signs of serious illnesses. A cough, for example, can foreshadow lung diseases like asthma, lung cancer, and mesothelioma, a fatal cancer of the lung lining whose high misdiagnosis rates prevent patients from undergoing lifesaving treatment.
Despite the urgency of diagnostic error, this is a branch of medical error we still know little about. According to the Department of Health and Human Services (HHS), efforts to improve patient safety have focused much more on medication errors, hospital infections, and postsurgical complications, even though diagnostic error is so common it accounts for 17 percent of preventable mistakes in hospitals. Not only that, but 9 percent of autopsies uncovered major errors that went undetected while the patient was alive.
Getting to the Root of the Problem
HHS suggests that diagnostic errors are caused by “subtle biases in clinicians’ thought processes.” Since they are unaware of these biases – particularly when they don’t see the outcome of their diagnoses – regular feedback may help doctors make more objective decisions.
However, these feedback systems only exist in computers, which haven’t yet been proven accurate. Information technology has improved clinicians’ ability to follow up on diagnostic tests quickly, but studies evaluating the effects of diagnostic performance on diagnostic error are also lacking.
Using Past Errors to Fix the Future
Following its 1999 report “To Err is Human,” the Institute of Medicine released a 2015 report recommending ways to improve diagnosis – not just through health information technology, but through human intervention.
Promoting teamwork, implementing large-scale feedback/correction systems, and enhancing patient engagement are among possible, but neglected, solutions. As other experts have agreed, doctors may need to take more responsibility for preventable gaps in care.
“Doctors’ visits these days tend to be rushed. That’s a big problem,” CBS News Chief Medical Correspondent Dr. Jonathan LaPook responded to the BMJ findings, adding that doctors need to take time to listen and talk to their patients. “Getting 95 percent right might be good on a school history test, but it’s not good enough for medicine, especially when lives are at stake.”