Conflicting diagnoses: ‘a mis’ or ‘an error’? —achieving quality in clinico-pathology consults

Abstract

Objective: People are constantly looking for quality products and services. Managers, including healthcare professional, globally consider quality as a strategic goal to achieve competitive advantage. Quality healthcare is the “Provision of appropriate standard healthcare in technically competent manner, with good communication, shared decision making and cultural sensitivity.” Referring a case for a ‘‘second opinion’’ is a traditional, formal approach to achieving quality in clinico-pathology consults. In the pursuit of quality in diagnosis via second opinion, some errors occur which not only breed confusion to the clinician, but also increases cost in terms of time, finance and complications on the patients. It is our aim to enlighten ourselves in order to eradicate this avoidable cost. Methodology: We present here six case scenarios to underscore not only the need, but also the ideal process for requesting second opinion to achieve quality in healthcare. The first was a case of an ulcerated breast lesion that was diagnosed as an inflammatory lesion by a pathologist, and non-Hodgkin lymphoma by another. The second was a pleural fluid cytology suggestive of malignancy and a second/reviewed impression suggestive of inflammatory (? Tuberculosis)/reactive (both negative for malignancy). The third was an abdominal lesion diagnosed as my fibroblastic tumour and a second diagnosis suggestive of inflammatory lesion. The fourth was a gastric tissue with first and reviewed diagnoses of inflammatory and malignancy respectively. The fifth was a case of divided breast tissue sent to 2 pathologists with no residual/residual tumour seen. Lastly, a ‘would have been divided’ endometrial tissue with a diagnosis of endometrial carcinoma in an endometrial polyp and relatively normal endometrium. Conclusion: Requesting second opinion in histopathology consults helps achieve quality in clinical care with minimal cost on clients when properly done.