A Second Opinion can make a Key Difference in Successful Treatment

Meet Dr. Florian Wolf, Diagnose.me expert on Cardiac Imaging, Vascular Imaging and Oncological Radiology and find out what does he thinks about second medical opinion:

Dr_Wolf
Florian Wolf, MD, Prof.

For me a real challenge in radiology is to detect a subtle secondary finding which is important but not the primary finding of the case. In some cases these secondary findings are clinically important and responsible for the patient’s symptoms.

In cardiac CT examinations of reduced quality due to artifacts, it is often tricky to read all the different phases of the ECG-cycle to get all the relevant information regarding the coronary arteries and all other cardiac structures. In cardiac MR examinations you sometimes have up to 50 sequences in one patient, which means you have to collect a huge amount of information in order to detect all findings.

Some weeks ago I got the CT images of a patient with 3 colorectal liver metastases. Over the last few years he had 22 cycles of chemotherapy with no chance of a curative therapy. I checked the size and location of the metastases and recognized that a curative therapy would be possible in this patient.

A few days later I did a portal vein embolization on the patient to induce a left liver lobe hypertrophy, and 4 weeks later the right liver lobe with the metastases was surgically resected successfully without complications. The patient is now free of symptoms and free of metastases.

Diagnose.me is a very professional, international service with experts from all over the world. Scrolling through the specialists offering their services on Diagnose.me is like exploring a Who’s Who of radiology.

Detailed Patient Information Increases the Chance of a Correct Diagnosis

Meet Dr. Alexander van Straten, Diagnose.me expert on Pulmonary Radiology, Cardiac Imaging and Oncological Radiology. Find out what he thinks about second medical opinions:

Dr_Straten
Alexander van Straten MD, PhD.

The most interesting and challenging cases involve patients that have had symptoms for a long time without a diagnosis. Of course it is not always possible to make a diagnosis based on the provided images, but if you do find the possible cause for the symptoms, it is very rewarding.

In most cases the images are pretty straightforward. Most patients have clear question that can be answered with a high degree of confidence. However, sometimes the diagnosis is less clear. It really helps though, when patients provide old examinations for comparison. It can also be useful to ask patients for more information about their symptoms, history, and family history. Finally, if no definite diagnosis can be made, it is important to tell the patient what follow-up examinations might provide more information.

I remember one case where the patient was told he had a benign cyst of the thymus, but unfortunately it was invasive thymoma. The patient went back to his doctor immediately to receive proper treatment.

When I first heard about Diagnose.me I was immediately enthusiastic. In my view patients always deserve a second opinion when they feel they need one. Before Diagnose.me getting a second opinion of your radiological examinations was almost impossible in the Netherlands. Now the possibility is there and at very competitive rates. I’m very happy to be part of the Diagnose.me team.

Is Your Health Really in Your Hands?

According to Bloomberg ranking, Singapore is one of the healthiest countries in the world. Other statistics show that it is the Netherlands or even Iceland. According to the latest report from The Commonwealth Fund, the United Kingdom ranks best in terms of health care.

The United States of America, the country with the world’s most expensive healthcare system, is ranked in 11th place. The impact of the healthcare system in each country, on its population is undeniable. Despite this, the fact remains that the responsibility for taking care of our health lies on each one of us as well.

Every country has its own way of dealing with medical problems. For example, just in the area of oral hygiene, according to a study made by the Colgate Association, problems are quite different. Hungarians visit dentists rarely. Poles consider consumption of a large amount of sweets to be their main problem. In the Czech Republic, people most often visit a dentist for dental control and treatment of dental cavities. Generally, patients from western countries are more conscious of their health issues and are more open to new possibilities of modern medicine (eg Telemedicine). However, there are differences even within the same country. For example, the residents of an Italian village Campodimele rarely live less than 95 years of age, while the average life expectancy of Italians is approximately 81 years. Even the World Health Organization has named this place the “Village of Eternity“. Locals have their particular diet derived exclusively from this region to thank. A big role is also played by genetics. However do not forget that, just as the residents of Campodimele benefit from their local food and less stressful lifestyle, we have the advantage of modern technology and available alternatives.

Doctor Google and Nurse Wikipedia

With the advent of new technologies, the internet has become the world’s number one counselor in health care. According to a report from the Institute for Healthcare Informatics, Wikipedia is one of the main sources of medical information not only for patients, but also for physicians. According to that report, up to 50% of doctors turn to Wikipedia especially for rare diseases. Another study again shows that, as many as one of three Americans have verified their health on the Internet. While 41% of people who sought this form of health information indicated that doctors confirmed their “online diagnosis”, another 35% did not even seek expert opinion after online search.

Many doctors and medical specialists, however, warn that there is a lot of incorrect medical information online. This fact is confirmed by the research made by a team of pediatrics whose main focus was the safe and healthy sleep of children. Within the research they analysed the first 100 pages of a Google search. Only 43.5% of the websites contained information that was in line with the recommendations of the American Academy of Pediatrics, while 28.1% of pages contained incorrect information and the remaining 28.4% of the sites were not even medically relevant. Although today‘s modern technology offers many new ways to take care of your own health, it is important to always consult with an expert. And if possible, even with a few experts for a second opinion. It is something on which we have a serious impact. Incorrect diagnosis and subsequent treatment of the issue may worsen the problem or cause other complications.

Diagnose.me provides online access to the world’s top specialists to help confirm or correct your scan results and diagnosis. You can choose your own specialist and get a response in as little as 48 hours. Be sure your doctor is making the right decision and be confident in knowing what comes next is best for you.

Already received a second opinion report from Diagnose.me? Get another one for free!

A second opinion can save your life by finding, confirming or correcting a patient’s diagnosis. Diagnose.me has helped hundreds of people from around the world to achieve better medical outcomes.

If you are among them, we want to hear from you. Sharing your story will help others to better understand how a second opinion can help them and the difference it can make.

If you want to share your story, let us know. We will get in touch with you soon! Once your story is published on our website, you get a consultation with another specialist at Diagnose.me for free.

I want to share my story

How has Diagnose.me helped other patients?

We have delivered reports to clients in more than 55 countries all over the world, and more than 25% of clients left us positive feedback.

Diagnose.me connects patients with professionals and centers of excellence where research and treatment is focused on a particular disease or organ. When treated in a specialized hospital chance of a correct diagnosis, fewer side effects and a better recovery are 3-times higher. The same goes for being diagnosed by a specialist rather than generalist. That’s why we reached these results:

Diagnose.me statistics

Second opinion matters. Share your story with us!

Twisted Ankle – What Next?

First of all, you need a good clinical examination so that the Doctor can determine the kind of damage you may have to the ankle. Many people have been referred for a so called “common sprained ankle” and it was anything but that!

Ankle twist Fig.1
X-rays : Such a large gap (diastasis) between tibia and the ankle (talus) in forced valgus (moving the foot laterally underneath the leg) shows both anterior talofibular and calcaneofibular ligaments are fully torn.

Let me give you the example of a top football player, who used to work for a great Spanish club. He was out of the game for two months when he came to me, and after a few questions and a simple clinical examination, it was obvious it was not a common injury. The CT-scan that his Doctor asked for showed a tear and luxation of a fibular tendon.

This demonstrates that a clinical examination is mandatory!

Although the clinical practitioner may think the injury is a common case, standard X-rays are still important to rule out the possibility of a fracture.

If a fracture is diagnosed, it changes the course of treatment, and a cast is mandatory.

Ankle twist Fig.2
Drawing of the normal ligaments : above is anteroinferior tibio-fibular, intermediate is anterior talofibular and the one below, calcaneofibular ligament.

Torn ligaments require simple immobilisation for 6 weeks, and, along with physiotherapy you should make it back on the field or to your favourite sport as fast as possible without complication. Immobilisation helps to perfect the healing of the torn ligaments. These ligaments are talofibular and calcaneofibular. Physiotherapy will help you into rehabilitation of proprioception of your ankle and exercising your muscles.

Ankle twist Fig.3
On X-Rays, fracture of the anterior tubercule of the calcaneum. It looks obvious to you on this image. You can not imagine how often such a fracture is missed on X-rays!

If the clinician thinks it may be more complicated, we add sonography to X-rays. Sonography will show if more than the usual ligaments are torn. There is a ligament between fibula and tibia, the anterior inferior tibiofibular. It is located 1 cm above the ligaments usually torn (talofibular and calcaneofibular). In this case the Doctor will see that you feel the pain a little bit higher up than you would in a common case.

Ankle twist Fig.4
On sonography axial slice , full tear of the anteroinferior tibiofibular ligament.

If a tear of the anteroinferior tibiofibular ligament is discovered, it will change the way your ankle will be immobilized, not at 90° dorsiflexion, but at 45° so that the ligament is not stretched on and will heal fast.

Do the right thing at the right time! If you are worried about your initial diagnosis a second medical opinion could put your mind at ease and put you on the right treatment path.

 

Patient’s story: Second Medical Opinion Confirmed Surgery was Necessary

Rastislav Machunka is a 42 year old manager from Trencin in Slovakia, who leads an active life outside his work. He plays golf, enjoys riding his bike and loves walking and horse-riding. Last summer, despite continuing to be physically active, his left knee started to hurt without any obvious cause.

ZVLaL - Rastislav Machunka
Rastislav Machunka

After six weeks of constant pain, Rastislav was worried that his knee ligaments or cartilage might be affected. He decided to have an MRI scan at a private clinic in Trencin. The general radiologist, who checked his MRI scan and the orthopedist who has subsequently seen him both recommended keyhole surgery to fix the problem. Even though the procedure was only minor, Rastislav was unsure that it was necessary.

“I wanted to make sure that I really needed the operation. It would be awkward for me to be out of action for 5-6 weeks, as I’m used to doing sports every day. It’s a great way for me to unwind after a busy day at work, plus sport helps me to stay fit. I didn’t want to lose any of this without giving it thorough consideration.”

Using Diagnose.me Rastislav got in touch with a Swiss musculoskeletal radiology specialist, Dr Pierre Gaston Benedict, for a second medical opinion.

“I was looking for a specialist who had extensive experience in dealing with the exact problem I was having. Using the filters on the Diagnose.me website, I could choose from multiple experts and finally decided on Dr Benedict.”

Within three days, Dr Benedict sent Rastislav a thorough medical report including detailed comments and images with pointing arrows to areas of his scan, describing and explaining his condition. The final conclusion of the Swiss expert confirmed the diagnosis of his Slovak colleagues, a damaged meniscus, which left untreated could over time cause serious damage to his cartilage. Rastislav passed on the second opinion report to his Slovak doctors who accepted the findings of their Swiss colleague.

Rastislav underwent surgery at a private clinic in Brno, Czech Republic. After five weeks recovery time, he’s well on his way to making full recovery, currently undergoing biologic regenerative treatment to help him rebuild his meniscus.

Rastislav concludes:

“When it comes to health, people should not save money. Knee surgery is not a major problem, but should anyone deal with a more serious medical issue I would urge them to consult another specialist. I can thoroughly recommend Diagnose.me.”

Diagnostic Errors – The Hidden Cause of Many Problems?

According to a study made by IOM (Institute of Medicine) as many as 100,000 Americans die each year due to misdiagnosis. Medical errors are one of the major causes of death in the United States.

Diagnostic errors are a huge health and economic problem. Their number in the last decade, according to the The American Journal of Medicine, despite progress in medicine has not decreased. On the contrary, it remains invariable. The same source also states that in America, in a period of five years, as many as 35% of people had experience with diagnostic errors. Moreover, as much as 35% of these cases resulted in permanent disability or even death. A study conducted by the peer-reviewed medical journal Mayo Clinic Proceedings in 2000, compared clinical diagnoses and diagnoses made at autopsy. The results show that major clinical diagnoses were not determined in 26% of cases. Regarding oncological diseases, the percentage of error is even higher – the Journal of Cancer indicates that 30% of first diagnosis of oncological diseases may be incorrect.

Types of Misdiagnosis

In general, the diagnosis can be correct, incorrect or delayed. Early studies in oncological diseases show that misdiagnosis can be more dangerous for the patient than a delayed diagnosis. For example, in the field of radiology which is crucial in determining the diagnosis, misdiagnosis occurs quite often. Studies estimate that the daily rate of errors in the interpretation of images is around 3-5%. Moreover, four out of five errors are due to incorrect perception.

In radiology, there are basically three types of errors:

  1. False negatives – where the doctor does not identify a real disease, happens as often as in 25-32% of cases
  2. False positives – where radiologists conclude that a healthy patient is suffering from a disease, happens in 1-62 % of cases
  3. Inconclusive results – where a doctor is not sure whether a disease is present, are very frequent, up to one in two cases in some diagnoses.

The Most Common Causes

There are many factors that may be the cause of misdiagnosis. Of course they include human error because of lack of experience, lack of equipment in hospitals, lack of technology, but also atypical symptoms of the disease. The radiologist who studies the MRI, CT or X-ray can be working in a busy room or simply has little experience with that health problem.

The most frequent errors in radiological diagnosis include:

  • lack of knowledge
  • poor communication (diagnosis is stated correctly by radiologist, but fails to be communicated properly by the treating physician )
  • flawed reasoning (identification of the findings but incorrect determination of cause)
  • satisfaction of search (this is a well-recognized phenomenon in which detection of one radiographic abnormality satisfies the ‘search’ and results in premature termination of the search)

A closer examination of the causes in the study shows that 90% of errors occur just from the last two reasons mentioned above. Clinical radiologist Erik Ranschaert from the teaching Hospital Jeroen Bosch Ziekenhuis in the south of the Netherlands and the Chief Medical Officer of Diagnose.me, also confirms that if the diagnosis is determined on time, the odds of successful treatment increase significantly. The fact does remain though that incorrect or late diagnosis may indeed have serious consequences, the best thing you can do for yourself and to ensure precise results is have more than one person look at your body images. Getting a second opinion from another expert reduces your risk of misdiagnosis from 20% to 4%. And, contrary to what you might think, getting a second opinion can be simple and affordable.

In the current figures and trends one must not forget that the number of tests is growing. The annual growth rate of radiological tests is between 10-20%. Analyzing the growing number of images and the growing complexity of imaging studies puts an increasing demand on radiologists. This may lead to more errors in interpretation in certain cases. Such errors can be eliminated with a second medical opinion. Studies show that a second expert opinion from a specialist radiologist reduces the risk of misdiagnosis by up to 90%. Moreover, waiting for hospital appointments and lack of professionals, in reality, is quite common. Modern technology now offers solutions. If you run into a similar “waiting” or “precarious” position in the case of radiological examinations, thanks to new possibilities, you can consult with world-class experts and get an expert second opinion almost immediately.

Diagnose.me provides online access to the world’s top specialists to help confirm or correct your scan results. You can choose your specialist and get a response in as little as 48 hours. Be sure your doctor is making the right decision and be confident in knowing what comes next is best for you.

Patient’s story: Diagnose.me Specialist Revealed Remaining Bone Fragments

In 2013, Adrian Coleman, a 37 year old Bioprocess Specialist fractured the radial head in his right elbow as a result of a fall onto a hard concrete surface.

Adrian had no surgery at the time, but had the injured arm in a sling for 5 weeks. As a very active person he became frustrated when he couldn’t enjoy sports like golf and squash which he regularly took part in. Adrian also has three children, and as a result of his injury found he was unable to be as active or as involved with them as he would have liked.

Adrian became worried about the number of set-backs he was having with his elbow and so requested and scheduled an MRI scan with his doctor. Even though the original MRI scan did pick up that there were some bone fragments left from the fracture, the report he received was vague and he decided to seek a second medical opinion. Adrian explained:

A. Coleman“I was undergoing physiotherapy to build back the strength in my elbow, however each time I was in the gym it was making it worse and within a few weeks the area was becoming sore and swollen. After receiving results from my doctor, I felt that the feedback wasn’t clear and I wanted more of an answer. I requested a copy of my scans, which I received immediately and then started thinking about getting a second opinion.”

He found out about Diagnose.me when searching for a doctor second opinion:

“I initially wanted reassurance that the report I had received was correct and I felt a second opinion would help to accurately assess the true cause of my pain. I have had to stop working my arm in the gym and as a result have put on some weight, so I was keen to find a solution.”

Adrian chose an experienced musculoskeletal radiologist, Dr Schueller-Weidekamm:

“I was impressed with her experience and the positive feedback she had received. Within 2 days I had the report back and I was delighted with the level of detail in it. I am so impressed with the service which has enabled me to go back to my doctor and discuss pursuing new treatment options.”

As a result of contacting Diagnose.me, Adrian discussed the results of his second opinion with his doctor, including the recommended treatments within the report and he is now awaiting a consultation in order to book an arthroscopy of the elbow to clean the joint and remove the remaining bone fragments.

Patient’s story: I’ve found the reassurance

Nicky, aged 40, primary school teacher (UK), comments her experience with her chronic back pain and second medical opinion:

Nicky H
Nicky, primary school teacher in UK

I have been suffering with chronic lower back pain for over 5 years and was becoming frustrated with the inconclusive reports I’d received from various specialists regarding the causes of my ongoing discomfort.

For the past 6 months, I’ve been seeing a chiropractor for regular massages – as well as carrying out daily, recommended exercises – but due to the conflicting advice I’d been given in the past, I hadn’t felt totally convinced that this was the right course of action for me. I was worried I might even be doing more harm than good.

When a friend recommended Diagnose.me, I was immediately intrigued by the prospect of being able to consult an international expert, without actually having to travel outside of the UK!

I found the site easy to use and within a few “clicks” my X-rays had been sent to the radiologist and musculoskeletal specialist, Dr. Laurence Bellaiche, in Paris (who I later discovered is a consultant to some of France’s top footballers!). As promised, Dr Bellaiche sent me a report within two days and I was relieved that she had made the same diagnosis (almost “word for word”) that had been given to me previously by two UK-based consultants.

Whilst Dr Bellaiche’s second opinion did not go so far as to highlight a new, radical treatment that might have helped my chronic back pain further – it did however provide me with the reassurance I needed. I now feel happy that I am following the right advice based on my existing diagnosis and will therefore continue with my current treatment plan and hope for slow and steady improvement.

Thank you!