The Gold Standard of Diagnosis

11:34 28 October in Health

A medical second opinion from a team of experts tends to yield the most accurate insights

The rise of chronic illnesses like cancer and heart disease, along with an aging population, has led to a situation where doctors must manage patients suffering from multiple health problems. As a result, clinical care is increasingly complex. At the same time, diagnoses and treatments are becoming more specialized and personalized. Several factors are contributing to changes in these areas and a medical second opinion may be one way to address the issue.

Factors contributing to increasing complexity of clinical care

First, the ability to quickly perform genomic analysis thanks to improvements in sequencing technology combined with advances in biomarker identification for specific diseases is providing a way to better diagnose patients. This is an area poised for great change. New bio-markers for different types of cancer are being discovered all the time. And application of the same techniques is expected to rapidly expand into other medical areas.

In particular, the importance of using bio-markers by clinicians is a critical new field for improving diagnoses and treatments. This was recently noted by a group of radiological researchers. They investigated biomarkers that inform clinicians and researchers about genetic events that drive the development of different tumors. Other bio-markers allow clinicians to properly indicate if and when a drug given to a patient has reached the tumor. “Once the oncologist has that information, they can now work on treating that patient in a more precise and personalized way, really targeting the treatment to the individual’s tumor,” said Sabrina Ronen, PhD, director of the Brain Research Interest Group (RIG) and professor in the department of radiology and biomedical imaging at UCSF.

Second, there is a deeper understanding of certain diseases. Comprehensive profiling at the molecular level has led to understanding that breast cancer is not as a single disease but “a heterogeneous complex of diseases, a spectrum of many sub-types with distinct biological features.”  Similarly, “lung cancer is really a collection of thousands of rare diseases that we have just classified as lung cancer,” according to one pharmaceutical industry executive.

And third, these trends are driving a transition in the way patients are treated. The healthcare industry is moving from a model of one-size-fits-all to segmenting patients based on genetic and other factors, using new therapies (some of which were developed based on bio-markers), and then personalizing treatment.

What’s needed?

Taken together, these changes mean that diagnosing aliments, planning a course of action, and selecting the right treatments is a much more complex process today, one that could benefit from a medical second opinion.

Unfortunately, traditional approaches to the delivery of medical services do not do a good job given these complexities.

Patients are frequently confused as to what to do next. They often go from sub-specialist to sub-specialist before finding someone who can diagnose their problems. Logistically, they must schedule multiple appointments and travel from one office to another. This can lead to critical delays in diagnosis and treatment. And worse, individual specialists frequently order redundant procedures and treat patients in isolation, with little coordination and input from one another.

To put the complexity of the situation into perspective, consider a typical (for today) approach to diagnosing a cancer patient and determining the best treatment options. A patient’s journey usually starts with some type of blood or imaging to discover a tumor. The next step would be to send the patient for a biopsy to more closely examine the tumor. Evaluating the results of the biopsy could require a pathologist and a cytologist.

Next, thanks to improvements in sequencing technology, a genetic analysis might be undertaken to understand the genetic makeup of both the individual patient and the tumor. Such understanding allows for highly-targeted therapy (sometimes called “precision medicine”) whereby cancer tumor characteristics and a patient’s genetic profile drive diagnostics, treatment guidelines, clinical trials, and cancer knowledge.

While use of genetic markers and associated treatment protocols are now considered standard, new markers are being discovered rapidly. Research in targeted and immuno-therapy is quickly adding additional layers of choice on top of these established treatment guidelines. For example, the patient might benefit from a new clinical trial focused on their specific form of cancer.

This process from diagnosis to developing a treatment requires the input of many specialists and sub-specialists. Most clinics simply do not have all the expertise under one roof. For this reason, it is increasingly being recognized that a better approach is for a patient to go to an organization that can draw on a multi-disciplinary team of experts at multiple institutions who will collaborate on all aspects of a patient’s care via a medical second opinion.

The complexity of making a correct diagnosis and then selecting the most appropriate treatment makes such a multi-disciplinary, multi-institutional approach necessary to avoid mistakes. A study by the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine pegged the magnitude of the misdiagnosis problem: Errors in diagnosis account for an estimated 10 percent of patient deaths, hundreds of thousands of adverse events, and a significant proportion of paid medical malpractice claims.

Better communication needed

The largest contributor to the problem is poor communication among healthcare providers. The IOM’s number one recommendation is to facilitate more effective teamwork among doctors, nurses, institutions, patients, and their families.

To be more effective, the diagnostic process needs to be a dynamic, team-based activity whereby healthcare professionals at different institutions — who have access to the types of technology described earlier — communicate effectively not only among themselves but also with the patient. This collaboration is more important to cancer patients than ever before thanks to rapid advances in detecting and profiling tumors.

In this way, a doctor who specializes in one field can call in specialists in different areas at different institutions to discuss and determine the best steps for diagnosis and therapy. Patients require fewer clinic visits, tests and procedures can be minimized, diagnostic errors can be avoided, and potential adverse events from separately prescribed treatments can be reduced.

For many healthcare organizations, assembling a team of multi-disciplinary specialists like this would be impractical. The needed specialists are likely geographically scattered, and the cost of maintaining a large staff of specialists each with diverse expertise is prohibitive.

You can have a team of specialists

There is an organization that provides this multi-disciplinary, institution-based approach. WorldCare connects their members and their designated physicians to foremost medical experts at top-ranked hospitals and research centers. WorldCare gives their members access to teams of specialists who review their cases and ensure the diagnosis is accurate and recommend an optimal treatment plan.

The company draws on only the most highly-ranked teaching and research hospitals across North America, all strategically affiliated with WorldCare, to provide clinically rigorous medical second opinions. When members enlist WorldCare to review their condition, they are enlisting a team of dedicated specialists and sub-specialists who are equipped with the latest medical knowledge.

WorldCare members don’t have to travel anywhere to see these specialists reviewing their case. WorldCare practices virtual medicine, providing a medical second opinion using digital communications. The company collects, reviews and consolidates all relevant medical records on behalf of their members while outlining the key questions their members and their treating physicians have about their condition. WorldCare then sends the member’s record and questions to a multi-disciplinary team for them to review and provide a confirmation of their diagnosis and recommended treatment path. Their findings are then sent back to WorldCare, who reviews all the information again and packages it together with other valuable information and resources and sends a customized WorldCare MSO Booklet back to their member and their designated physician. The WorldCare MSO Booklet contains a confirmation of their diagnosis and provides them both with treatment plan recommendations. Years and years of medical expertise — applied to each case and delivered to the member’s door.

“We replicate digitally what it’s like to walk into one of the finest medical institutions in the world,” says Richard Heinzl, MD, MPH, Global Medical Director at WorldCare. “Our goal is to provide the most accurate diagnosis and best outcomes for anyone dealing with a serious illness. Our multi-disciplinary, multi-institutional approach enables us to do that. That’s why we think of it as the gold standard.”

Learn more

See “WorldCare’s Simple Process for Getting a Medical Second Opinion” for more details about how WorldCare reviews cases and delivers medical second opinions. If you are not a member, contact your insurer or employer to let them know about this important service. If you are interested in offering this service to your employees or eligible members, contact WorldCare at