A recent study by researchers from the Mayo Clinic in Minnesota found that more than 20% of patients who seek a second opinion had been misdiagnosed by their primary care providers.

“Effective and efficient treatment depends on the right diagnosis,” said James Naessens, a healthcare policy researcher at the Mayo Clinic, who led the study.

Only 12% of the patients had received correct diagnoses

In the study, researchers investigated medical records of 286 patients referred by their primary healthcare providers to Mayo Clinic between 2009 and 2010.

Results showed only 12% of the patients who visited a second physician to review their cases had received correct diagnoses. While almost 66% of patients had a slightly changed diagnosis, 21% of them had a completely different condition.

“Diagnosis is extremely hard,” said Mark L. Graber, a senior fellow at the research institute RTI International and founder of the Society to Improve Diagnosis in Medicine, who was not involved in the research. “There are 10,000 diseases and only 200 to 300 symptoms.”

Last year, a controversial study by Johns Hopkins University said that medical errors, which include mistakes in diagnosis, are the third-leading cause of death in hospitals behind cancer and cardiovascular diseases in the US.

Meanwhile, a report from National Academy of Medicine estimated that diagnostic errors cause up to 10% of patient deaths, and up to 17% of all hospital complications. Among 12 million people, approximately 5% of adults who seek outpatient care are said to be misdiagnosed annually.

The report also mentioned that most people receive incorrect or late diagnosis at least once in their lives, sometimes with severe consequences.

Medicine should be a collaborative process

The researchers said there are several factors to why misdiagnoses occur. For instance, health insurers often limit the access to care outside of their network in order to save healthcare costs, thus referrals are limited.

Besides, primary care providers may be overconfident with their diagnostic expertise or struggle to keep themselves updated with the latest guidelines and medical development. There are also doctors who lack the confidence to bring up their difficulties or uncertainties for discussion, similar to patients who do not have the knowledge or confidence to request a second opinion.

“This may prevent identification of diagnostic error, and could lead to treatment delays, complications leading to more costly treatments, or even patient harm or death,” Naessens said. “We want to encourage second opinions when the provider is not certain.”

“Doctors are humans, and they make the same cognitive mistakes we all make,” Graber said. “If you are given a serious diagnosis, or you’re not responding the way you should [to medication], a second opinion is a very good idea. Fresh eyes catch mistakes.”

Hence, as the results show, medicine should be a collaborative process as doctors and other healthcare providers should communicate more among each other in order to ensure patients receive the right diagnoses. Both Naessens and Graber said additional advice might in turn save costs and lives.

“Most of the stuff you learn in medical school is kind of useful background noise, but it doesn’t tell you anything about the patient in the bed,” said Lisa Sanders, a physician and author of Think Like a Doctor. “[Medicine] is teamwork.”

Nevertheless, it is also worth noting that the sample size for this study is relatively small thus further studies on misdiagnoses are certainly necessary. MIMS

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