Feature Article

The Importance of Second Opinions

A recent ABC news story cited a study by researchers at The Johns Hopkins Hospital in Baltimore, Maryland that found an alarming rate of medical misdiagnoses among pathologists. In a review of 6,000 tissue samples from cancer patients at hospitals around the country, the Hopkins team found that one out of every 71 cases was misdiagnosed. Biopsies were labeled cancerous when they were actually benign (noncancerous); those that were cancerous were sometimes misclassified as the wrong type of cancer.

"That can change whether a patient gets no treatment, vs. surgery, vs. radiation," warned Hopkins' Dr. Jonathan Epstein in the report.

Similarly, a study presented at the annual meeting of the American Roentgen Ray Society in Seattle reported that simply double-checking a mammogram can often catch a cancer that was initially missed.

Dr. Susan Harvey of the University of Vermont College of Medicine and colleagues analyzed the records of 25,368 mammograms. The initial radiologist noted a suspicious finding on 3,209 of the films. Importantly, a second look at the original films by another radiologist found suspicious findings on an additional 379 films. This in-house second opinion resulted in the finding of 11 new cancers that would otherwise have gone undetected.

A New Prognosis or Treatment

Last year, the publication Clinician Reviews revisited an earlier Johns Hopkins study that evaluated the records of 6,171 patients who were referred to Hopkins for treatment following a biopsy between April 1995 and December 1996. Eighty-six of the cases (1.4 percent) were diagnosed differently by Johns Hopkins pathologists than they had been by the original pathologists. Eighty of the 86 new diagnoses (93 percent) resulted in a revised treatment plan; 61 of the new diagnoses (71 percent) led to an improved prognosis.

In 23 percent of the cases that were misdiagnosed, patients who were thought to have cancer instead had benign tumors, and thus avoided unnecessary cancer treatments. In 5 percent of the misdiagnosed cases, tumors said to be benign were in fact cancerous, possibly saving the lives of the patients. Other cases were misdiagnosed as the wrong type of cancer, e.g., a melanoma was misdiagnosed as stomach cancer.

You Have a Right to a Second Opinion

Patients should always seek a second opinion on procedures for which there is any difference in medical opinion. Even when there are no treatment alternatives to sort out, a second opinion can offer a fresh perspective if there's a vexing clinical problem. Or it can confirm a diagnosis or the wisdom of a course of treatment, and thus ease any doubts that you, or your physician, may have.

When seeking another opinion, make sure to discuss this with your primary physician. If you sense reluctance or defensiveness on your doctor's part, that's all the more reason to get a second opinion. Walking away from a physician who leaves you frustrated or angry, or just uncomfortable, may be one of the most important things you can do to take charge of your health.

Unfortunately, many patients are hesitant to get a second opinion because they are afraid of damaging their relationship with their doctor. Yet all patients are entitled to an independent second opinion and to get a copy of their medical records. Your primary physician should not only support this process, but should provide you with a list of specialists that he or she would personally recommend.

"Misdiagnosed Cancer Not Uncommon," ABCNEWS.com, May 9, 2001
101st Annual Meeting of the American Roentgen Ray Society, May 1-3, 2001, Seattle, Washington
Clinician Reviews, 2000; 10(2):115-123

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