Laura Landro, in her Wall Street Journal column, "The Informed Patient," has taken on the controversial subject of second opinions in medicine.
Inevitably, the "attention-grabber" of such an article is an anecdotal patient initially "misdiagnosed" at one institution who goes to another institution, gets the right diagnosis (and the right treatment), and is healthy now. I certainly don't want to minimize the issues here--not at all. But pathologists really need to get out in front of this issue. Hopefully, the College of American Pathologists will officially provide a response.
But more importantly, we must implement and communicate the quality assurance activities in place designed to minimize misdiagnosis in surgical pathology and cytopathology. The author does quote Hardeep Singh, chief of the health policy and quality program at Houston's DeBakey VA Medical Center as stating that "a growing number of centers are requiring an internal second review of pathology reports to prevent misdiagnosis. If the second opinion differs markedly, a third opinion may be necessary to get a consensus on what course of treatment is best." Who isn't already doing this? A more nuanced and balanced approach to this article might have been to interview a (at least one!) practicing pathologist to get some context (check out the sidebar "Changing the Diagnosis"--where did this come from?) as well as specifics on the challenges of making diagnoses and what we do to confirm diagnoses--especially when cancer is being considered. There has been a great deal of pathology literature in the last ten years identifying and addressing the problems and concerns raised in this article. It sure would have been nice if this had been noted.
Despite what the public is led to (or wants to) believe, there is no infallible, 100% guaranteed diagnostic test out there for cancer--and (sorry!) never will be (with all due respect to the Human Genome Project). Sure, a wand would be nice. But, in the meantime, there will be an irreducible level of uncertainty because of variation at every step of the diagnostic process from the patient herself through molecular testing on the tumor to individual response to treatment. We cannot be nihilistic about this and must try to minimize variation at the diagnostic/interpretive level. But we can also clearly communicate to ourselves, our colleagues, and the public the steps we are taking to minimize misdiagnoses.
Please share any innovative strategies you or your colleagues are taking for quality assurance in surgical pathology.