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Expert consultation services...

Discussion in 'Pathology' started by cmz, Apr 20, 2017.

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  1. cmz

    cmz Pathology Wannabe 10+ Year Member

    854
    32
    Sep 6, 2001
    Texas
    Physician
    Can a PCP or subspecialist request a second opinion on any pathology case at their home institution without the approval of their home pathology group? My view is that the PCP/SS patient is under their direct care and supervision and if they want to request material from their home lab to be sent to an "expert" they are within their right to do so. After all, pathologists are just consultants anyway. The only reason I ask is because I do not want to step on anyone's toes...
     
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  3. univlad

    univlad Member 10+ Year Member

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    Jul 14, 2002
    Yes. Though it would be courteous to discuss the case with signing pathologist.
     
  4. coroner

    coroner Peace Sells...but who's buying? 10+ Year Member

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    Aug 3, 2007
    22 Acacia Avenue
    Physician
    Absolutely, the clinician can make that decision independent of pathologists. And technically, the second opinion cannot be done without the home pathology group's indirect approval. They (home path group) has to sign a form to release the slides to another facility (second opinion place) documenting slides were sent. So by default, the home path group is providing approval.

    My colleagues and I would never disapprove this and I've never heard of any path group doing otherwise. It'd create bad blood between with clinicians by refusing to do so. And legally, the patient can demand an outside consult regardless of the home path group's approval or not.
     
    Last edited: Apr 20, 2017
  5. dhpath

    dhpath 2+ Year Member

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    1
    Jan 5, 2013
    I would rather encourage the clinicians to get a second opinion. After few months/few cases they will develop confidence on the in house pathology. Also, you are not going to pay for it. Most of the insurance will pay for a second opinion.
     
  6. mikesheree

    mikesheree 7+ Year Member

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    Feb 27, 2010
    Physician
    You also have to review what is being sent out to assure it is the diagnostic/representative material.
     
  7. medgator

    medgator Senior Member 10+ Year Member

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    Sep 20, 2004
    Physician
    Yes. Sometimes the patient wants a second opinion and part of the protocol at larger cancer center is to review the path at their institution when they are being seen by that center's clinicians
     
  8. KCShaw

    KCShaw Chief Resident 7+ Year Member

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    Oct 25, 2007
    There's probably some legalese or case precedent somewhere addressing particular rights, tissue/slide ownership, and all that. That notwithstanding, in practice a pathologist does have to "approve" the request, and the surg path department certainly has to know about it in order to get the material ready and ship it out. But I can't recall a pathologist/group in a hospital setting which wasn't willing to let recuts go out to someone else by clinician request -- so long as who was paying for what was sorted out first. Occasionally there can be problems if there is extremely limited tissue of interest, or an outside consultant insists on seeing the actual original slides/tissue; this can come up in cases undergoing litigation, where the original institution doesn't want to release custody of the primary material and the consultant doesn't want to physically go to the original institution to do their evaluation. Pathologists can be viewed as consultants, but in the context you're talking about the original pathologist also has the primary responsibility of issuing a tissue diagnosis -- tissue is literally signed over to them by requisitions and these patients are also their patients, at least as much as that of the cardiologist and nephrologist and oncologist and surgeon and so on.

    But in common practice, asking for a 2nd path opinion is unlikely to be stonewalled unless there is a "who-is-paying-for-what" issue going on, it's happening absurdly often, or some such. That doesn't mean they aren't going to want an explanation or that they won't feel a bit slighted -- pathologists already will send out for a consult if it's thought to be indicated, and most people have a little professional pride, such that they want their clinicians to have confidence in them. While it's common for a patient to go for a second clinical opinion and that second institution to request recuts or whatever for their local pathologists, almost always explained in a request letter if not by phone, it could be considered a little rude & unprofessional to ask them to send out for a second path opinion without any explanatory communication at all. Talk to them about what you want and why, how confident they feel with the diagnosis, etc., and see if you can agree on a course of action.
     
  9. BamaAlum

    BamaAlum 10+ Year Member

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    Jun 5, 2001
    The only issue I have encountered is when a local clinician wants a second opinion and they try to determine where I send it. Usually, this is to some reference lab that has marketed to them and they have bought the lie that these guys are "experts" in their particular field. We have adopted the policy that we will send out a case for a second opinion at any time, but it must go to an academic center. Usually, we send it to our closest academic center. I don't mind a consultant disagreeing with me, but I would like them to have the clout of an academic institution behind them. Furthermore, it is my opinion that as pathologists we are in a much better position to determine who is considered an "expert" in our field. Of course, cases where the patient is going to be treated at the requesting institution are sent without question, but these patients are going to academic or tertiary referral centers anyway.
     
  10. BamaAlum

    BamaAlum 10+ Year Member

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    Jun 5, 2001
    Caveat: if a patient wants the case to go to a particular pathologist or institution (ie. another private practice) we will send the case with no questions asked. The above only applies to the rare case where a local clinician requests a second opinion from a reference lab.
     

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