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Is it proper to comment in reports on another's diagnosis?


Mark A. Hurt MD

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Here is the situation: I received a telephone call from a dermatology colleague who wanted my opinion, a second opinion, on a patient's specimen. It was, I was told, a melanocytic proliferation and that my opinion of it was needed so that a definitive surgery could be planned. I reviewed the specimen, and my opinion was similar to the first dermatopathologist.

Now my question: Is it proper to comment in reports on another's diagnosis?

As a rule, when one agrees with the prior report, it will not usually pose a problem. What, however, occurs when one disagrees or agrees only in part? How should that be handled? Should one reference the earlier report? Should one remain silent about the prior report and produce one's own report without any reference to the prior report?

I have an opinion on this, but it want to hear from you before I explain my point of view.
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Dr. Mona Abdel-Halim

Posted

In such situations, if I agree, I call the clinician and tell him that my opinion is the same so no need for another report. If I disagree, I write a report mentioning that the slide was sent for second opinion and I do not mention the first opinion. I think it is the right of the patient and the clinician in such cases to have a documented second opinion.
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Mark A. Hurt MD

Posted

Hi Dr Mona,

In the US, as a rule, when consulted, one has to render a report to make an official record. I will wait for a few others to respond before I elaborate further.

Mark
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Robledo F. Rocha

Posted

Dr. Hurt,

Whenever I’m requested for a second opinion, I always ask the clinician to write down formally his/her uncertainties. So, I make my report based on those specific uncertainties, taking care to avoid any direct comment on another’s opinion. In doing that, I think it’s possible to disagree or agree only in part, without exposing outright to litigation who signed out previously.

After all, I always send my second opinion report to the first pathologist.

I wish I would learn from many other colleagues about their professional conduct on such situation.
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Guest Jim Davie MD

Posted

[b]For second opinion/consult reports requested by a clinician[/b], the motivation is frequently a concern or doubt regarding the validity of the original pathology diagnosis. In this scenario, I would:
(1) render a second opinion diagnosis,
(2) correlate this with the original diagnosis, and
(3) provide rationale for agreement or disagreement with the original diagnosis, if required.
The consultant is arguably qualified to correlate the original and consultation diagnoses, and determine a level of agreement; the clinician may not be. Therefore, the consultant can best help answer the clinician's doubts regarding the original diagnosis by documenting this correlation (with opinion of the level of agreement) in the consultation report comments.

[b]For second opinion/consult reports requested by another pathologist[/b], I believe the focus of the consultation focus is different; the consultant's diagnosis, not the referring diagnosis, is the center of attention.
In this scenario, I would render a consultation opinion without mentioning the provisional diagnosis, especially if disagreement exists.
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Mark A. Hurt MD

Posted

Thank you, Jim.

My usual practice is to render a diagnosis based on my own opinion without reference to the other report unless I agree with the referring pathologist. In cases in which the dermatopathologist is the referring, I render my diagnosis and attempt to address his or her specific questions. Rarely, I will include an additional letter of explanation. Of course, all of this is discoverable in the courts, so all correspondence must be considered "in camera" and written as if addressing a jury.

Best,

Mark
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