No diagnostic disagreement


Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements.

Second opinion in pathology is intended to expose clinically significant errors that have a direct impact on patient care. Before definitive treatment of referred patients, our institution requires a second opinion of outside surgical pathology slides. We sought to determine if this local standard of practice has a measurable impact on patient care via clinical and pathologic follow-up. 5629 second opinion surgical pathology cases seen at the University of Iowa Hospitals and Clinics were studied. Each case was classified as: no diagnostic disagreement, minor diagnostic disagreement, or major diagnostic disagreement by the second opinion pathologist at the time of referral. A major diagnostic disagreement was defined as a change in pathologic diagnosis with potential for significant change in treatment or prognosis. Major diagnostic disagreements were categorized by organ system and according to the clinical significance of the changed diagnosis based on clinical and pathologic follow-up. Second opinion surgical pathology resulted in 132 (2.3% of total cases) major diagnostic disagreements and 507 (9.0%) cases with minor disagreements. The organ systems involved in the majority of the major disagreements were the female reproductive tract (32), gastrointestinal tract (27), and skin (24). Of the 132 major diagnostic disagreements, 68 (1.2% of total cases reviewed) prompted changes in the clinical management as a result of the second opinion interpretation. These findings support the idea that mandatory second opinion is an important part of patient care in the referral setting.

http://www.ncbi.nlm.nih.gov/pubmed/18360282

--------------------------------------------------
Note added at 1 day2 hrs (2016-04-24 13:05:06 GMT)
--------------------------------------------------

Pathology second opinions can be valuable even with no change in diagnosis

After the consultant has rendered a second opinion, he/she will send a report to the Original pathologist. If there is a difference of opinion, the original pathologist will either agree with, or defer to, the diagnosis as made by the consultant, who typically has subspecialty expertise in the area in question. The consensus diagnosis will then be issued in an amended or addended report by the Original pathologist.

If there is a difference of opinion and the original pathologist stands by his diagnosis, then it is the responsibility of that pathologist to communicate with the consulting pathologist and make his case for why his original diagnosis should stand (e.g., perhaps a focal diagnostic area on a single slide was initially missed by the consultant). If after thorough discussion they still can’t agree on a consensus diagnosis and plenty of lesional tissue is available for their review, then together they should select a well-known expert consultant to have the final say. If the diagnostic problem is due to a small amount of tissue being available for evaluation, and additional tissue is easily and safely obtainable, then it may be better to get a better tissue sample.

In disagreements of this sort, if the two pathologists do not initiate a conversation on their own, then it would be appropriate for the patient’s physician to contact the initial pathologist to prod him into starting a dialogue. Please note that each pathologist is more likely to stand his ground in cases in which neither of them is a recognized expert, as commonly occurs in cross-town slide reviews where a patient has a biopsy at one location and scheduled surgery at another. In these situations, it is usually not difficult for both pathologists to agree to defer to the diagnosis of a mutually selected expert consultant.

https://disqus.com/by/RogerReichertMDPhD/


--------------------------------------------------
Note added at 1 day3 hrs (2016-04-24 14:13:07 GMT)
--------------------------------------------------

Hello Anna, normally you would wait a minimum of 24 hours before awarding points.

I don't know about the technicalities since I never posted a question on Kudoz.