I’ve stewed over this for years, since 2013 when he was first arrested. But ever since Farid Fata was sentenced to 45 years in prison (ONLY 45!) for fraud, I’m like a dog with a bone. I just can’t let go.
Last week I took at look at the Farid Fata case. He is the (former) oncologist who sentenced 553 people to their death or a lifetime of illness or financial bust by lying to them – telling them they had cancer they did not have, then treating them with chemo they didn’t need and ruining their lives. The 45 years he’ll spend in prison were not for the heinous crimes of destroying their health, instilling fear, breaking their hearts and stealing their hard-earned money. Rather he was penalized for defrauding Medicare and insurance.
Beyond the obvious disturbing and distressful aspects of this case, beyond my personal bias about misdiagnosis, and certainly beyond my real sympathy for the victims, is a big concern I have for advocates. Misdiagnosis, whether intentional or not, is happening with more frequency as doctors are spending less time with their patients. It is no stretch to see the responsibility for determination of a correct diagnosis as falling more squarely on the shoulders of advocates.
Despite the fact that we are not doctors or diagnosticians, our role in making sure clients get the right answers will become even more prominent as time goes on. For many reasons we can NOT afford to get it wrong!
Last week’s post was about the steps private advocates would have taken that would have prevented their clients from falling for these intentionally imposed misdiagnoses. Four steps. Four services advocates know to perform. Each by itself could have stopped a client-patient from being misdiagnosed.
But the bone I can’t let go of actually stems from a comment made by one of the post’s readers, Cindi, in reaction to one step – seeking a second opinion.
“Fata was many patients’ second opinion. He offered a better solution…. To assume none of his patients sought a second opinion is insulting…”
For one thing, it never occurred to me that Fata would have been the second opinion oncologist, and would have ended up treating people who had already received an opinion. It should have, but it had not.
But secondly, the more I think about it, that very fact proves that
…a second opinion is no longer good enough.
I think we need a new regard for the second opinion, a more defined best practice, a higher standard of advocacy care. When a second opinion is called for, we must insist our clients seek an objective, second confirming opinion.
Let’s break it down:
One thing we know is that doctors are human beings who, like all human beings, have friends and colleagues and professional regard for each other. Ask any doctor and he or she will tell you that “other doctors” (because they don’t consider themselves fallible enough to do this themselves) will rarely contradict their friends or colleagues.
Further, there is confirmation bias. That is, that the suggestion of an answer or solution cements that same answer or solution in a second person’s mind. This is further affected by how much respect (or fear) doctor #2 has for doctor #1, or even how lazy doctor #2 is, or how much of a hurry he or she is in.
(I can also tell you from personal experience that this takes place even in labs. In my own story, the specimen ( a lump) removed from my torso was sent from lab #1 to lab #2 for a “second opinion.” Lab #2 simply regurgitated the wrong answers from lab #1’s paperwork.)
We have to wonder how many of Fata’s misdiagnosed patients actually went to a second oncologist and were given the same information, the same misdiagnosis, because the second oncologist was either a friend or colleague, or found it just easier for whatever reason to confirm that misdiagnosis?
This points out the need for objectivity in a second opinion – finding a second opinion professional who has no relationship whatsoever to the first opinion professional. In appropriate cases (potential cancer, or lifelong debilitating diagnoses, or recommendations for surgery, etc) as advocates, we must be sure that our clients see an objective second person for an opinion – a doctor who lives and works in another location, who doesn’t practice within the same health system, whose kids don’t play on the same school teams or who don’t go to the same church or temple or mosque. If that means we must find a doctor in another city, or on the other side of the state – or the country – then – we must.
Because not insisting on that objectivity is at least a waste of our clients’ time, and possibly money. At worst, it may be limiting them to wrong answers which will lead to wrong treatment, which can have a harmful effect on their quality and quantity of life, harm that could have been prevented.
Knowing those 553 people didn’t have cancer, no matter whether Fata’s misdiagnosis was the first or second opinion – his opinion must have been a different opinion.
(Or was it? See “objective” above.)
In the perfect world, a patient would see two unrelated (objective) doctors and get identical answers about diagnosis and treatment options; confirming information that would allow him to make the right decisions for himself based on that now-confirmed information. If testing was involved, then the tests would be accurate, and their results would be easily viewable, too.
If a second opinion is that cut and dried and was known to be as objective as possible, then the advocate’s second opinion support job is done.The diagnosis is confirmed.
But we don’t live in a perfect world and rarely is it that simple.
A second opinion that is not the same as the first one calls the question “which one is correct?”? And since there is no second, confirming opinion, the job is not done. The correct answer hasn’t been achieved. The patient-client needs to get a third opinion, in hopes of confirming one of the first two. And it needs to be sought from someone who is professionally and personally removed from the first two to be sure it’s objective.
Still not confirmed after three opinions? Then it’s time to look for a fourth. Because no one can know which of the first three is the right one. The patient can’t simply choose the one he or she likes the best!
The patient may need multitudes of opinions. But only two of them need to agree. THAT is the second, confirming, opinion.
The New Gold Standard
This is the new gold standard in advocacy: helping our patient-clients find objective, second confirming opinions.
To be clear, it’s not that I’m trying to prevent a redux of this Fata case. I can’t imagine in my lifetime a second Farid Fata anymore than I can imagine a second Ted Bundy or John Wayne Gacy.
No. This is about understanding what it’s like to be misdiagnosed and have one’s life totally upended because of it. It’s about making sure misdiagnosis, one of the most preventable of medical errors, is routinely uncovered so patients-clients get what they really need.
What do you think> As advocates, are we willing to begin promoting, and overseeing a new standard of diagnostic determination?
Are you willing to say that for all appropriate clients, you will insist on helping them seek an objective, second confirming opinion?
I think you must. Because to do any less puts their lives – and our profession – in jeopardy.
Find additional posts about the Farid Fata case and patient advocacy:
- How Professional Patient Advocates Would Have Stopped Farid Fata
- Revisiting the Case of Farid Fata ? Why Patient Advocates Must Take Notice
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