Initial diagnoses can sway physicians' 2nd opinions, study suggests

Information about a patient's initial diagnosis can influence physicians offering a second opinion and may even lead to incorrect diagnoses, according to a study published Aug. 10 in JAMA Dermatology.

The study, led by researchers at Los Angeles-based UCLA Health, involved 149 pathologists tasked with interpreting real skin biopsies from 90 patients. First, researchers had pathologists interpret the biopsies without any knowledge of other physicians' diagnoses. A year later, researchers had the pathologists assess the same biopsies, some of which were accompanied with information about another pathologist's diagnosis of the case.

Pathologists were more likely to give a more severe diagnosis when they knew the first opinion was severe, and they offered a less severe diagnosis when the original opinion was less severe, study authors found. This trend occurred even among participants who said they were "not at all influenced" by initial diagnoses in a baseline survey. 

"The extensive amount of sway noted in this study points to the complexities of the diagnostic process. A concerning finding of this study was that knowledge of the first diagnoses also swayed pathologists away from correct diagnoses," Joann Elmore, MD, a professor of medicine in the division of general internal medicine at UCLA's David Geffen School of Medicine, said in a news release. "Physicians providing second opinions should be blinded to the first opinions if the goal is to obtain an independent diagnostic opinion."

View the full study here.

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