Why Second Opinions Count

Actress Rita Wilson, who recently announced her breast cancer diagnosis and subsequent double mastectomy, did the right thing when she sought out a second opinion. And doing so might have saved her life.

But too many of us are hesitant to question a medical diagnosis: a 2005 Gallup Poll that surveyed 5,000 Americans found that about half reported "never" seeking a second opinion and a paltry 3 percent always sought out a second opinion on a diagnosis, treatment, drug or operation.

Even after four years of college, four of medical school, and three to seven more of residency, doctors still may not get diagnoses right on the first try.

In fact, they’re more likely than not to be at least a little off. In a study published (paywall) April 4, researchers from the Mayo Clinic in Rochester, Minnesota found that 88% of the time, a patient’s original diagnosis changed at least slightly when a second medical professional was consulted.

Misdiagnosing a patient can sometimes be fatal, but how often is unclear. Last year, a controversial study from Johns Hopkins University said that medical error which includes mistakes in diagnosis are the third-leading cause of death in hospitals behind cancer and cardiovascular diseases in the US.

As ProPublica notes, doctors don’t list medical errors on death certificates, so counting the actual number of deaths presents its own set of challenges. That said, the National Academies of Medicine estimates (pdf) that diagnostic errors lead to up to 10% of all patient deaths, and up to 17% of all hospital complications.

For the Mayo Clinic study, physicians gathered the medical records of 286 patients who visited a primary healthcare provider between 2009 and 2010. Each patient was either prompted to seek a second opinion, or found one on their own every single one did get a second opinion, though.

Only 12% of the patients came out of visits to a second physician with the same diagnosis; 66% of patients had a slightly altered diagnosis, and about a fifth were told they were suffering from a completely different condition.

The fact that these patients sought any kind of second opinion means their cases were probably not straightforward. But even if they were, diagnosing is never easy. “There are 10,000 diseases and only 200 to 300 symptoms,” Mark Graber, a physician and founder of the Society to Improve Diagnosis in Medicine, told the Washington Post.

There’s an innumerable amount of combinations of symptoms that a patient could bring to a doctor, which could indicate one of those 10,000 diseases, or a number of them. The more symptoms you add, the more complicated it becomes to match them to different diseases. And there’s no limit to just how many illnesses from which a patient can suffer.

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