Every year in the US, twelve million people are affected by medical diagnostic errors, while more than forty-thousand die as a direct or indirect cause of this misdiagnosis. In a developed country with arguably the finest health care system in the world, you have to stop and ask yourself - Why?
In our opinion, there are several contributing causes, with one simple solution. At the core of this issue are three systemic causes that our healthcare system needs to overcome in order to avoid this catastrophic result: insurance, electronic health records systems and hubris.
Health Insurance Dictates Physician Behavior
Anyone with health Insurance that has ever seen a doctor understands this issue well. Insurance reimbursement drives physician behavior. How much time and attention a physician or practice can afford to spend in a patient visit is a direct result of their expected insurance payout. If you’ve been to a doctor’s visit lately, you likely noticed that the time you spend actually being diagnosed seems shorter than ever. It’s not your imagination playing tricks on you.
A 2018 survey regarding time primary care physicians spend with their patients revealed some patients had
less than nine minutes with their healthcare providers, while others had between 17-24 minutes.
Electronic Health Systems Are Distracting Physicians
In your last doctor’s examination, did the doctor spend more time facing you or his or her screen? Most patients (and physicians) would answer the latter. Legal requirements and insurance reimbursement again drives physicians to record specific detailed data on every patient visit. While the purpose for doing so (electronic portable health records) is admirable, the result is that a significant portion of the already short patient visit is spent with the physician acting as a scribe rather than a diagnostician.
Doctors study in their profession for many years prior to receiving their license and their ability to perform actual patient exams. Yet, the human body is still an extraordinarily complex mechanism with new diseases arriving all the time. It is virtually impossible for the average practitioner to know everything he or she needs to know in order to identify the cause and treatment for every patient malady they encounter. This is true for specialists and remains true when supplemented with artificially provided computer intelligence. It should come as no surprise that your doctor —even when given sufficient time by insurance coverage to examine and diagnose the patient while avoiding the distraction of spending too much time recording information in their electronic health record — may still get it wrong, despite the best of intentions.
And they do. Some studies indicate that as few as twelve percent of patients receive a completely correct diagnosis and treatment plan.
Misdiagnosis kills, disables, and is the leading cause of malpractice claims. It also generates $750 billion in wasted money for unnecessary medications, procedures, work time lost and more. You don’t need to be a rocket scientist to realize that together, the costs of these undesirable outcomes is enormous — more than enough to pay for a better process.
So, Why NOT Make Second Opinions the norm?
Many professions and processes routinely require a secondary review of their work. They do this without feeling mistrusted, inadequate or second guessed. Researchers who write scholarly articles usually require peer review prior to publication. Drug companies run extensive trials to check and recheck the efficacy of a drug. Accountants have their financial audits peer reviewed prior to issuing their opinions. Writers have editors that read and reread their prose. Bankers regularly institute Second Review loan officers. Mortgage lenders often require a second review of an appraisal. The list goes on.
Why don’t we just institute second opinions as a standard part of the health care process? After all, this is your life and wellbeing on the line.
Though a second opinion is often an added expense, it’s money well spent when it helps to avoid additional costs generated by our healthcare system, unnecessary prescriptions and tests, and malpractice claims. More importantly, second opinions save lives and preserve health when errors are avoided.
Making it Easy to Get a Second Opinion
To efficiently and cost-effectively get a second opinion, you need to be able to get your current diagnosis, treatment recommendation, and test results to another physician. This might be a colleague of your current doctor practicing in a different location, or it might be a specialist who has been trained in more defined practices around the illness (or lack thereof) in question. Regardless of where the doctor is located, you’ll want to find a way to seamlessly electronically transmit a clearly articulated request, along with your records to the second physician.
The clearer it is that your current physician is a party to this request, the more apt an out-of-state physician will be to participate in this second opinion. If your second physician is actually rendering the opinion as a consult with your initial doctor, that almost always gets him or her sufficient legal standing to issue the opinion without violating state practice regulations.
The costs of a second opinion today are generally borne by the patient. However, the more we can remove the stigma, convince insurance companies that it is in their interests to participate and demonstrate the value of second opinions, the more we will find that it is in everyone’s interests to normalize obtaining a second opinion in serious medical matters.