Pathologist misdiagnosis in the news

[caffeinegirl]

Patients informed of cancer misdiagnoses, as Providence reviews pathologist’s work

FOX 12 Investigates has heard from seven patients who had lab results reviewed incorrectly by a single Providence pathologist.

www.kptv.com

Looks like the pathologist has about 20+ years in practice. This is why having confirmation with a second pathologist on malignant diagnoses (especially first time diagnoses) is important.

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[octopusprime]

Getting a second signature on an obvious breast cancer isn't what keeps me up at night. It's calling something benign and missing the 1mm focus of cancer hiding near a calc on the edge of the slide, or the handful of STIC cells on a ligation, or the thyroid tumor I call follicular adenoma but someone else calls follicular carcinoma after a met is found 4 yrs later. Most of those kinds of errors are from rushing or trying to get too much done on a Friday afternoon.

 

[path19]

You're right about confirming malignant diagnoses. But I would argue it's why having confirmation with a second pathologist on benign diagnoses is even more important. If you have an obvious malignancy and misgrade or even misclassify the tumor, it's not as egregious as missing the malignancy altogether.

 

[cmz]

Patients informed of cancer misdiagnoses, as Providence reviews pathologist’s work

FOX 12 Investigates has heard from seven patients who had lab results reviewed incorrectly by a single Providence pathologist.

www.kptv.com

Looks like the pathologist has about 20+ years in practice. This is why having confirmation with a second pathologist on malignant diagnoses (especially first time diagnoses) is important.

Experience doesn't matter if you're a turd to begin with, and I would argue that you would just get worse as times goes on. There are a lot of systems out there that turn a blind eye to quality issues. It isn't until something like this happens when real action is taken.

On a side note, there is such a thing as herd mentality where everything you show to members of your "team" reach a positive consensus. In my group, if we don't reach 100% consensus, we send the entire case out for second opinion. Having more voices helps; however, there are a lot of solo practitioners out there who don't have this luxury.

 

[Zarniwoop]

Hard news for the patient and for the public in general, but why did this get published? Doesn't seem particularly unique or newsworthy.

 

[caffeinegirl]

+1 - agree that QA/QC issues are important - and also agree with the point to double check benign as well as malignant diagnoses - missing malignancy at the edge of a core in one level of the slide is also a recurring nightmare of mine

 

[caffeinegirl]

Just another plug for AI screening tools too....I've seen AI tools that pick up foci of tumor that the pathologist missed the first time around.

 

[SunBakedTrash]

Hard news for the patient and for the public in general, but why did this get published? Doesn't seem particularly unique or newsworthy.

Doom and gloom sells, even without a full story. Why was the pathologist telling her the diagnosis directly? Was it an onsite FNA that he called benign and someone else called cancer?

He looked at me and was like, ‘they’re most likely benign.’ And I was like, ‘what do you mean, most likely? Like, how do you definitively answer that? Most likely isn’t a good enough answer.’ And he’s like, ‘I’ve been doing this for 30 years. I’m really good at reading these. You’ve nothing to worry about in my opinion. They’re benign.’ So I didn’t think I had to question it anymore,” said Vickers.

Do y’all practice pathology like this?

 

[Guest8]

Doom and gloom sells, even without a full story. Why was the pathologist telling her the diagnosis directly? Was it an onsite FNA that he called benign and someone else called cancer?

He looked at me and was like, ‘they’re most likely benign.’ And I was like, ‘what do you mean, most likely? Like, how do you definitively answer that? Most likely isn’t a good enough answer.’ And he’s like, ‘I’ve been doing this for 30 years. I’m really good at reading these. You’ve nothing to worry about in my opinion. They’re benign.’ So I didn’t think I had to question it anymore,” said Vickers.

Do y’all practice pathology like this?

That was the part I didn't get. Is he running an FNA clinic somewhere somehow? I don't talk to patients. Like ever.

 

[RE-Tired]

1. We don't have enough information; I couldn't tell from the article who gave her the dx; really not clear.
Only way I see it could have been the pathologist was if it was an FNA. Who still does FNA of breast? I did a breast FS and have done hundreds.
I am still celebrating even though retired that breast FNA is out of favour. I feel very fortunate I was never sued.
2. Soap box here - why are breast needle core biopsies 88305? It is absurd. It should be in a higher paying code and secondary review should be highly encouraged. Ever since I started pathology over 40 years ago, the billing categories for surgpath are a big part of what makes path not desirable.
Did prostate bx go from 88305 x6 to 12 or even 20 because of how difficult they are? In my entire career I read both breast and prostate and the skill required for reading breast biopsies are at least a magnitude higher. Now done bit-----.

 

[octopusprime]

1. We don't have enough information; I couldn't tell from the article who gave her the dx; really not clear.
Only way I see it could have been the pathologist was if it was an FNA. Who still does FNA of breast? I did a breast FS and have done hundreds.
I am still celebrating even though retired that breast FNA is out of favour. I feel very fortunate I was never sued.
2. Soap box here - why are breast needle core biopsies 88305? It is absurd. It should be in a higher paying code and secondary review should be highly encouraged. Ever since I started pathology over 40 years ago, the billing categories for surgpath are a big part of what makes path not desirable.
Did prostate bx go from 88305 x6 to 12 or even 20 because of how difficult they are? In my entire career I read both breast and prostate and the skill required for reading breast biopsies are at least a magnitude higher. Now done bit-----.

The billing doesn't make sense for most specialties...though yes it is particularly bad for path.
Why can't I upgrade an appendix with an incidental carcinoid, or worse a goblet cell carcinoma? I don't care that the surgeon went in with the intent to do an appy and this is incental, it's still a neoplasm...whereas taking out an ovary for endometriosis is 88305 but if it ends up having a serous cystadenoma or teratoma that makes it an 88307?
Numerous billing books I have say that while a lymph node dissection is an 88307, if only 1 node is found in that big glob of fat, I should downgrade to 88305?
Why are sebKs 88305 while tags and EICs are 88304?
Why are these 5 sentinel lymph nodes 88307 because the surgeon labeled them 'sentinel' while the 6th was just labeled "additional node" and it's an 88305?
We could do this for hours...

 

[WEBB PINKERTON]

The article clearly states that the patient was referred to the pathologist for a biopsy. It must have been a misdiagnosed breast FNA, since he talked to her during the procedure. I didn't even realize anyone was still doing those. We did them in the 1990s but I haven't done one since probably the year 2000.

The article also said this: "The cases that FOX 12 Investigates has reviewed involve tissue samples from breast biopsies, thyroid removals, and cervical cell samples gathered during pap smears."

Either the cytopath is making errors and/or the specimens are typical cytopath garbage specimens leading to errors (or ambiguous dx leading to more invasive procedures). Or the article is just a bunch of fear mongering by people that don't understand what we do.

Remember, two of the top 5 things you will be sued for involve cytopath. It is a very high risk, no reward path.

The ONLY reason why a cytopath fellowship is coveted in practice is so the group has some idiot to offload the specimens on.

 

[ScubaV]

Agree with others, why is the patient being scheduled with the pathologist and why is he giving results directly? Has to be breast FNA which is outdated and inappropriate if there's even remote suspicion of malignancy. Even so, how and why is the PCP informing her that the results are wrong a year later? Did someone request a second opinion or is this a bizarro world where pathologists do biopsies and PCP's interpret them?

I definitely agree with showing cases around. Get confirmation of malignancies and show atypical/suspicious stuff. The problem with apparently benign cases is there might be nothing to show unless your group is fine with duplicating work. For breast, for example, I might get someone to agree with sclerosed papilloma or UDH without atypia, but if I miss the lesion then it's missed. No one's going to have two pathologists entirely review one case for one bill.

 

[path19]

Some groups definitely have two pathologists entirely review one case for one bill. It's limited to certain specimen types (i.e. all breast biopsies, all prostate biopsies, etc)., but it certainly happens.

 

[PATHDOCNYCNJ]

Experience doesn't matter if you're a turd to begin with, and I would argue that you would just get worse as times goes on. There are a lot of systems out there that turn a blind eye to quality issues. It isn't until something like this happens when real action is taken.

On a side note, there is such a thing as herd mentality where everything you show to members of your "team" reach a positive consensus. In my group, if we don't reach 100% consensus, we send the entire case out for second opinion. Having more voices helps; however, there are a lot of solo practitioners out there who don't have this luxury.

I was in a practice where the one where the boss had the loudest voice and drove the consensus and you were seen as blind or stupid if you thought differently from her. Plus she routinely denied requests to use IHC and threatened pathologists that they would be paying for any “unneeded” stains.

 

[cmz]

I was in a practice where the one where the boss had the loudest voice and drove the consensus and you were seen as blind or stupid if you thought differently from her. Plus she routinely denied requests to use IHC and threatened pathologists that they would be paying for any “unneeded” stains.

That definitely goes hand in hand with the herd mentality. It's very dangerous if someone steers discussions in this manner. All this perpetuates are clones (which you don't want) and "yes men." I would say this sounds like a toxic environment, but it is a toxic environment all together. God bless her wherever she is right now.

 

[ScubaV]

Some groups definitely have two pathologists entirely review one case for one bill. It's limited to certain specimen types (i.e. all breast biopsies, all prostate biopsies, etc)., but it certainly happens.

Wow, never heard of this before. Sounds like a scenario where someone got burned and clinicians lost trust. Maybe that will happen to whoever's doing pathology for this Oregon place.