One of the reasons patients come to Mayo Clinic is to obtain a second opinion. This can be lifesaving.
In a recent research publication, Extent of diagnostic agreement among medical referrals, a Mayo Clinic physician-scientist team showed that for a group of 286 patients referred from primary care providers to Mayo Clinic’s General Internal Medicine Division between 2009-2010, the second opinion resulted in a new or refined diagnosis 88 percent of the time.
“It’s important to note that most diagnoses in the primary care setting are on target,” says James Naessens, Sc.D., a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and the study’s senior author. “What we really want is to encourage providers to take advantage of another set of eyes – especially in the case of complex conditions and undifferentiated diagnoses.”
As a tertiary care center, Mayo Clinic offers patients access to medical, surgical and research staff who concentrate on developing thorough knowledge of specific diseases and treatments. These specialists work with a collaborative team-based approach, collectively offering the Mayo Model of Care, and with it, confident assurance that their answers will be correct.
“Primary care providers don’t always have the resources necessary to completely and accurately diagnose complex conditions and undifferentiated symptoms,” says Thomas Beckman, M.D., study co-author and a general internal medicine doctor at Mayo Clinic.
“We believe that the extra time our Mayo Model of Care allows us to spend with the patient is invaluable,” says Dr. Beckman. “We also incorporate evidence-based discussions within the context of learning teams, and have access to large-scale laboratory and test standardization. Our tools, like the integrated electronic medical record and scheduling systems, enable efficient and effective care. Plus colleagues across all subspecialties are ready and willing to provide internal consultation to ensure speedy and accurate diagnoses for our patients.”
Co-author Robert Lohr, M.D., a hospital internal medicine doctor at Mayo, agrees, “We are fortunate to have access to cutting edge technology, an integrated practice with a passion for innovation and continuous improvement, and a shared vision: ‘the needs of the patient come first.’”
Despite the pervasiveness of diagnostic errors and the risk for serious patient harm, diagnostic errors have been largely unappreciated within the quality and patient safety movements in health care. Without a dedicated focus on improving diagnosis, these errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity.
While the study authors admit more work needs to be done in understanding the diagnostic process and diagnostic errors, they all agree that second opinions need to be encouraged when appropriate.
“Second opinions are an important part of the continuum of good health and high-value health care delivery and should be readily available for patients who need them,” says Dr. Naessens. “It’s a critical issue that network-limiting cost controls, as well as other factors, negatively impact.”
He says that he and his team are pleased by the National Academy of Medicine’s call for dedicated federal funding for improved diagnostic processes and error reduction. They also plan further research on diagnostic errors and hope to identify ways to improve the process.