Diagnostic Concordance (Numbers 23:19)

“The University is requesting the melanoma case you read out yesterday!”

It was a request for a second opinion originating from the patient’s surgeon. My staff retrieved the patient’s slide with a copy of my diagnostic report and mailed it to the university. A week later, our office received a fax of the university dermatopathologist’s diagnosis. Thankfully, he agreed and concurred with my diagnosis. The patient could now undergo his definitive treatment; both he and his treating physician were confident of the diagnosis I rendered. However, this is not always the case. Occasionally there is a slight disagreement between my diagnosis and the other consulting dermatopathologist. Usually there are no serious medical consequences and the treatment is the same. The converse is also true. I am often consulted by other laboratories, dermatologists, and dermatopathologists to render an expert opinion and while I am usually in agreement, there are also occasions when there is a minor disagreement. 

Several well designed studies have investigated this issue. Even amongst expert pathologists, there may be a wide range diagnostic concordance with melanomas and atypical moles. Perhaps even more disturbing is when the same case was blindly given to the same pathologist, their own diagnostic concordance sometimes differed by as much as 10%, depending upon the type of cancer and the complexity of the diagnosis. Breast cancers, prostate cancers, cervical cancers-all of these different cancers have their own ranges of diagnostic concordance. 

It is not only pathologists who fall victim to this lack of diagnostic concordance. Radiologists, psychiatrists, internists-every medical specialty exhibits a degree of lack of diagnostic concordance amongst its everyday practitioners and experts. If even the experts in medicine cannot uniformly and completely agree upon a diagnosis, how can a patient have confidence in their diagnosis? This is why second and even third opinions rendered by reputable institutions and experts are always recommended for patients to seek out before receiving definitive treatment. 

When God renders a diagnosis on my life and reveals a truth, am I willing to accept it without question? Sadly, I sometimes wonder if God is correct. Do I need another opinion? Perhaps God would change His mind if He reviewed my circumstances once again? Is God consistent with His own decisions or is He fallible like the medical experts who cannot be internally consistent with their own decisions?

God is not a man, so he does not lie. He is not human, so he does not change his mind. Has he ever spoken and failed to act? Has he ever promised and not carried it through?

Numbers 23:19 (NLT)

In medicine and in life, we may seek different opinions to help us make a decision. In the back of our minds, however, we may wonder if the opinion that is given can be trusted. Thanks be to God that we can always be confident that His decisions are the correct ones. He is not like us and susceptible to changing His mind. He is eternally consistent with all of His decisions regarding my life and for everyone who has ever existed. 

When I allow God to take control of my life, I can have complete assurance that my life is in complete accordance with His divine guidance. 

Amen!

Love and trust the Lord; seek His will in your life.

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