Comments on: The value of a cancer diagnosis second opinion

By: Anne Orchard

Anne Orchard — Wed, 09 Sep 2009 15:16:30 +0000

I also wonder how this works in practice, especially in the UK. My feeling would be that second opinions are unusual events requested by very few patients – or possibly demanded by their family members. How would a patient who is not medically trained know that there is any room for doubt? Perhaps this is a time for an accompanying family member to innocently ask ‘What is the degree of confidence in these results?’ Perhaps if this was a standard question second opinions from unrelated pathologists would become more common (though I cannot imagine how the NHS would manage this in practice).
Thanks for raising this topic, it is very enlightening.

Anne Orchard
Author ‘Their Cancer – Your Journey’
http://www.familiesfacingcancer.org

By: bev M.D.

bev M.D. — Wed, 09 Sep 2009 15:16:07 +0000

To alban berg;
Of course all the biases also infect the original pathologist, so you are not really saying anything new. That is why the new advances in molecular medicine will eventually turn pathology into just another lab test, instead of the subjective judgments that go on now. This is a good thing, although it will take awhile. Another advance is telepathology so that expert opinions can be obtained remotely, especially valuable in rural areas.
As for those biases, however, do not assume that the pathologist’s partners agree with him/her just to be nice. On the contrary, at times!!!

By: alban berg

alban berg — Wed, 09 Sep 2009 02:48:19 +0000

One of the great economic failures (and that’s saying something) in medicine is patient’s inability in most settings to choose radiologists or pathologists. People are often just stuck–as in the hospital environment.

In an economically rational world, pathologist/ radiologist error rates would be public, and patients would pay variable rates depending on the degree of reliability they need.

Instead, you have a kabuki dance in which the healthcare consumer (who pays for the show) begs her almighty doctor to make a call. Kinda makes me sick.

btw bev M.D. made me laugh. Ever hear of confirmation bias, interest bias . . . . all the other well proven cognitive biases that infect our reasoning that the social psychologists have discovered? Given these biases, I’m not sure what an intragroup second opinion is worth. A tabula rasa when looking at a film might be invaluable . . . (oh , even better, how bout a computerized expert system_

By: Wendy S. Harpham, MD

Wendy S. Harpham, MD — Wed, 09 Sep 2009 01:55:22 +0000

Dear Bev MD,
Thanks for your helpful comment.
With respect, Wendy

By: Nuclear Fire

Nuclear Fire — Wed, 09 Sep 2009 00:18:54 +0000

Ditto with radiology reports.

By: bev M.D.

bev M.D. — Tue, 08 Sep 2009 21:39:51 +0000

As a pathologist, I concur with your post, with a few caveats.
First, most pathologists practice in a group, and it is very common to obtain a second, third or fourth opinion from others in their group. This is free to the patient, and is usually recorded on the pathology report as “this case was reviewed by Dr. X who concurs with the diagnosis.” Second, how is the patient to tell if his/her biopsy changes are obvious or subtle? This is where his physician comes in. If the language of the pathology report is ambiguous (such as saying “consistent with breast cancer”, rather than just “breast cancer”, or “suspicious for breast cancer”), the physician needs to call the pathologist and really ascertain the pathologist’s level of confidence in the diagnosis. I have seen clinical physicians act on a diagnosis of “suspicious for” as if it were a definitely positive diagnosis.
To keep this short, the first question a patient in the above situation should ask of their physician is, “have you talked to the pathologist by phone?”
If so, you can be more confident that the case has been thoroughly discussed. If not, either ask them to call or ask for another opinion.