Should You Get A Second Opinion?

Dr Vernon Coleman

Many patients automatically trust their doctor – assuming that he or she must always be right. But that can be a deadly mistake.

It has always been diagnostic skills which have differentiated between the good doctor and the bad doctor. Treating sick people is easy. If you are a doctor and you know what is wrong with your patient you can look up the correct treatment in two minutes. Sadly, however, many doctors seem to have lost their abilities to diagnose accurately.

1. When researchers examined the medical records of 100 dead patients who had been shown by post mortem to have had heart attacks they found that only 53% of the heart attacks had been diagnosed. What makes this even more alarming is the fact that half the patients had been looked after by experts in heart disease.

2. A study across 32 hospitals which compared the diagnoses doctors had made when treating 1,800 patients with the diagnoses made after the patients had died (and could be examined more thoroughly) showed that doctors had an error rate of nearly 20%.

3. A study of 131 randomly selected psychiatric patients showed that approximately three quarters (75%) of the patients may have been wrongly diagnosed.

4. In many cases patients are diagnosed as having – and are then treated for – serious psychiatric problems when their symptoms are caused by drugs they have been given for physical problems. Whole wards full of patients have been diagnosed, treated and classified as schizophrenic when in fact they were suffering from side effects produced by the drugs they had been given by prescription happy doctors.

5. When 80 doctors were asked to examine silicone models of female breasts they could only find half the hidden lumps. A 50% failure rate even though the doctors knew that they were being tested and observed. * Another study showed that doctors had missed diagnoses in dying patients up to a quarter of the time. Experts concluded that one in ten patients who had died would have lived if the correct diagnosis had been made.

6. Another study revealed that in two thirds of patients who had died, important, previously undiagnosed conditions were discovered in the post mortem room.

7. A report published after pathologists had performed 400 post mortem examinations showed that in more than half the cases the wrong diagnosis had been made. The authors of this report said that potentially treatable disease was missed in 13% of patients; that 65 out of 134 cases of pneumonia had gone undetected and that out of 51 patients who had suffered heart attacks doctors had failed to diagnose the problem in 18 cases.

All this is terrifying. For if the doctor doesn’t make the right diagnosis then it doesn’t matter how many wonderful drugs he has at his disposal.

There are many reasons why today’s doctors are so bad at making the correct diagnosis.

Education is often lamentable – with lecturers too often teaching medical students about organs and tissues rather than living patients, and then examining them on their ability to remember huge lists of details about bones, blood vessels and pathology details without ever testing them on their ability to use the information they have acquired.

And studies have shown that doctors are at their worst when dealing with patients with whom they feel uncomfortable. Narrow training means that doctors feel uncomfortable with a wide range of people. They often have difficulty relating to, talking to or acquiring information from people of ‘different’ races, sexes or social backgrounds.

An even bigger problem is the fact that modern doctors rely far too much on technology – and far too little on building up any diagnostic skills of their own.

Old fashioned doctors used to rely on what their patients told them and on what their own eyes, ears, noses and fingertips told them. Most important of all, perhaps, was the sixth sense that doctors used to acquire through years of clinical experience.

Modern doctors rely too much upon equipment which is often faulty, frequently badly calibrated and more often than not downright misleading.

For example, nearly every published study on the subject puts the error rate for doctors reading X-rays at between 20% and 40%. Radiologists working at a big hospital disagreed on the interpretation of chest radiographs as much as 56% of the time. And there were potentially significant errors in 41% of their reports. Even when X-rays are read for a second time only about a third of the initial errors are spotted.

So, the lesson here is a very simple one: do not automatically assume that your doctor’s diagnosis must be right. If you are at all unhappy about the diagnosis – and feel that your doctor could be wrong – insist on a second opinion.

Taken from the international bestselling book `How to stop your doctor killing you’ by Vernon Coleman

`How to stop your doctor killing you’ is available as a paperback and an eBook.

Copyright Vernon Coleman October 2023