On January 17th of this year an excellent article entitled What if the Doctor Is Wrong? appeared on the front page of the Personal Journal section of the Wall Street Journal. Laura Landron wrote a very thoughtful and informative piece…up to a point. What she failed to do was to tell the reader that the diagnostic issues involving unusual tumors, about which she wrote, have been dealt with for years by obtaining a more expert opinion. By omitting this factual information, indeed, by the nature of the title itself, she created sensationalism for her piece, but more destructively, she created a false impression and a dangerous one at that of misdiagnosis.
The physicians in the case initially described acted appropriately and within the standards of care of the community. The question then is where did the doctor go wrong? Tumors are very difficult things to diagnose at times and require a pathologist specifically trained not only in oncology, but also in the subspecialty tumor area in question. While Ms. Landron makes these points, she fails to place them in the appropriate context; that is, these procedural pathways that were followed in her opening example were not only correct, but are followed every day, even at Harvard, and at times require the physician to request a second opinion of a specifically trained pathologist in the tumor area under consideration.
Sadly then, the context of the essay is placed after the fear of misdiagnosis of a cancer is inaccurately created. By doing so, and possibly understanding that few people read an entire essay, she is not only intellectually dishonest with respect to the order of her presentation, but potentially risks negligently interfering in a doctor-patient relationship. My issue is not with what she wrote, but how it was written. More importantly, she failed to address one of the major issues that cause a misdiagnosis of anything… physician face time spent with the patient, taking a thorough history and performing a thorough evaluation, instead of relying on diagnostic and expensive tools to make the diagnosis for her. The problem is that under the current system, there is no time to perform these critical activities!
Second opinions are extremely important when dealing with difficult to diagnose tumors and other conditions beyond those referred to in the cited article. The essay correctly states the issues involved. For difficult to diagnose tumors, Ms. Landron’s posted questions are critical to ask, and they should be utilized in every instance of tumor diagnosis, even for common tumors. Sometimes even after a second opinion for a tumor diagnosis such diagnosis may still be in doubt. In that case, you are best served being treated in a recognized tumor center.
Medicine and our knowledge of disease is evolving rapidly and what was treatment even 5 years ago, especially with tumors, is possibly not treatment now. The speed of change has created the necessity not only for the specialist but also for the subspecialist in most areas of medicine. So where does all this leave you, the patient? In an age where we need to keep costs down, when is it appropriate to ask for a second opinion? When is it appropriate to get a second opinion? The questions to ask as detailed by Ms. Landron in instances of doubt, not only for tumors, but also for any uncertain medical diagnosis, act as an excellent guideline, but what of the future with respect to advancements in diagnosis and treatment of most medical conditions? Does the current healthcare law address these cost issues with anything other than an allegedly independent panel that will make decisions as to what is and is not paid for?
In the end, the responsibility lies with you to look after you, and with you to look after your family. The Federal Government is out of money, so you must be an informed and prudent consumer of healthcare. You must seek another opinion if there is any doubt about a diagnosis that can change your life and/or how you live it. No amount of legislation will alter that, only you will. You are your own best advocate and fiscally responsible consumer of healthcare.