Second opinions often influenced by first diagnosis
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Dermatopathologists were often influenced by prior diagnoses when giving second opinions, especially in challenging cases, according to a study.
“When we make a medical diagnosis, we care about patients, and we want to make certain it’s accurate. So, I often get second opinions, but I was surprised at how little research actually goes into the process of getting second opinions,” Joann G. Elmore, MD, MPH, professor of medicine at the David Geffen School of Medicine at UCLA and the study’s lead author, told Healio.
In the two-phase study, skin biopsies from 90 patients were analyzed by 149 pathologists using the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification system.
During the first phase, pathologists examined and diagnosed cases without any prior diagnosis information. In the second phase, the dermatopathologists were sent the same images more than a year later, accompanied with another diagnosis from an experienced board-certified and/or fellowship-trained dermatopathologist.
A total of 5,322 interpretations were completed in the two phases.
When information of previous diagnoses was provided, dermatopathologists were significantly more likely to be swayed toward that diagnosis. Compared with when no prior diagnosis information was provided, the likelihood of a lower diagnosis was 1.38 times higher when the earlier diagnosis was lower and the likelihood of a higher diagnosis was 1.52 higher when the earlier diagnosis was more severe.
“The most alarming part of these data is that pathologists were swayed away from an initial correct diagnosis,” Elmore said.
A baseline survey conducted before the study asked participants their perceptions of second opinions, and most agreed they were helpful to reduce misdiagnoses and overdiagnoses. Despite 85% preferring to receive the prior diagnosis before providing a second opinion, none of the participants reported that information to be a great influence on their decisions.
“This shows that we are not aware of our own biases. I think we doctors need to be a bit more aware,” Elmore said. “When appropriate, second opinions can be helpful, but perhaps we have to reconsider how we are obtaining them. It might be helpful for the person giving the second opinion to be independent and blinded to any information to give a fresh perspective.”