Utilization of second opinion pathology consults by clinicians: a cross sectional study
Keywords:Clinicians, Pathology consults, Second opinion, Utilization, Awareness
Background: Pathology diagnosis is key to critical decision making in clinical medicine. In clinico-pathologic consults, there may be errors in pathologic diagnoses resulting in delayed or inappropriate treatment, hence impaired quality of care. Seeking a second opinion on a pathology consults is one procedure that enhances quality of healthcare services. In the spate of medical litigations, some doctors are either not aware of the procedure or do not utilize second opinion pathology consults (SOPCs).
Methods: This cross sectional study used an online structured questionnaire to assess the awareness of and utilization of SOPCs by clinicians in Nigeria. Information regarding socio-demography, cadre, years in practice, reasons for utilization or non-utilization and modalities for seeking SOPCs were collected.
Results: Of the 511 respondents, 75.7% of whom practiced in government-run tertiary hospitals, 33.5% have never utilised SOPC. Surgeons (29.7%) and gynaecologists (12.1%) are the major users of SOPCs; utilization of which is associated with cadre (p= 0.001) and not years of practice (p= 0.199). 24.3% divided specimen between pathologists, 15.5% sent a fresh specimen, 15.2% and 24.1% sent out the same slides and tissue blocks respectively, used for the first diagnosis. 65.8% SOPC requests were not accompanied with the first pathologist’s report.
Conclusions: SOPC is an important component of a total quality assurance that helps reduce the overall cost of patient care. Many clinicians are not aware of SOPC procedure, hence the under-utilization. It is our opinion that proper enlightenment of clinicians will bridge this gap in knowledge and enhance better practice.
Cook IS, McCormick D, Poller DN. Referrals for second opinion in surgical pathology: implications for management of cancer patients in the UK. EJSO. 2001;27(6):589-94.
Hillary Clinton quotes. Available at: www.quotemaster.org. Accessed 10 Dec 2022.
Mosadeghrad AM. Healthcare service quality: towards a broad definition. Int J Health Care Qual Assur. 2013;26(3):203-19.
Schuster MA, McGlynn EA, Brook RH. “How good is the quality of healthcare in the United States?” Milbank Q. 1998;76(4):517-64.
Shmueli L, Davidovitch N, Pliskin JS, Balicer RD. Hekselman I, Greenfield G. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Israel J Health Policy Res. 2017;6(1):67.
Di Cerbo, Palmieri B. The economic impact of second opinion in pathology. Saudi Med J. 2012;33(10):1051-2.
Frable WJ. Surgical pathology-second reviews, institutional reviews, audits, and correlations: what’s out there? Error or diagnostic variation? Arch Pathol Lab Med. 2006;130(5):620-5.
Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: The National Academies Press; 2000.
Committee on Diagnostic Error in Health Care, Board on health Care Services, Institute of Medicine, National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press; 2015.
Loehberg CR, Meyer J, Häberle L, Hack CC, Jud S, Hein A, et al. Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center. Arch Gynecol Obstet. 2020;301:1299-306.
Tomaszewski JE, Bear HD, Connally JA, Epstein JI, Felman M, Foucar K, et al. Consensus conference on second opinions in diagnostic anatomic pathology. who, what, and when. Am J Clin Pathol. 2000;114(3):329-35.
Woolgar JA, Triantafyllou A, Thompson LDR, Hunt JL, Lewis Jr. JS, Williams MD, et al. Double reporting and second opinion in head and neck pathology. Eur. Arch Otorhinolaryngol. 2014;271:847-54.
Middleton LP, Feeley TW, Albright HW, Walters R, Hamilton SH. Second-opinion pathologic review is a patient safety mechanism that helps reduce error and decrease waste. J Oncol Pract. 2013;10(4):275-81.
Elmore JG, Tosteson ANA, Pepe MS, Longton GM, Nelson HD, Geller B, et al. Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study. BMJ. 2016;353:i3069.
Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 2015;313(11):1122-32.
Davidson NE, Rimm DL. Expertise vs evidence in assessment of breast biopsies: an atypical science. JAMA. 2015;313(11):1109-10.
Nakhleh RE, Bekeris LG, Souers RJ, Meier FA, Tworek JA. Surgical pathology case reviews before sign-out: a College of American Pathologists Q-Probes study of 45 laboratories. Arch Pathol Lab Med. 2010;134(5):740-3.
Leong AS, Braye S, Bhagwandeen B. Diagnostic ‘errors’ in anatomical pathology: Relevance to Australian laboratories. Pathology. 2006;38(6):490-7.
Tsung JSH. Institutional pathology consultation. Am J Surg Pathol. 2004;28(3):399-402.
Lueck N, Manion EM, Cohen MB, Weydert JA. Institutional second opinion. Pathol Case Rev. 2009;14(2):62-5.
Malherbe J. Counting the cost: The consequences of increased medical malpractice litigation in South Africa. S Afr Med J. 2013;103(2):83-4.
Di Cerbo A, Palmieri B. The economic impact of second opinion in pathology. Saudi Med J. 2012;33(10):1051-2.
Woolgar JA, Ferlito A, Devaney KO, Rinaldo A, Barnes L. How trustworthy is a diagnosis in head and neck surgical pathology? Eur Arch Otorhinolaryngol. 2011;268:643-51.
Al-Maghrabi JA, Sayadi HH. The importance of second opinion in surgical pathology referral material of lymphoma. Saudi Med J. 2012;33(4):399-405.
Mba LS, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, et al. Second medical opinion: utilization rate and characteristics of seekers in a general population. Med Care. 2016;54(10):921-8.
Selman AE, Niemann TH, Fowler JM, Copeland LJ. Quality assurance of second opinion pathology in gynecologic oncology. Pathol Rev. 1999;94(2):302-6.
Brigham and Women Hospital. Surgical pathology consultations/second opinions. Available at: www.brighamandwomens.org. Accessed June 22 2023.