Outcomes of second opinions in general internal medicine

Abstract

Background To date, the outcomes of second opinions in internal medicine in terms of diagnostic yield and patient benefit have not been studied extensively. This retrospective study explores the outcomes of second opinions at a general internal medicine outpatient clinic in an academic hospital. Methods A register of all patients referred to the general internal medicine outpatient clinic of the University Medical Center in Utrecht for a second opinion, was kept. All 173 patients referred between June 2016 and August 2018 were selected. Case records were analyzed for patient characteristics, referring doctor, chief complaint, performed investigations, follow-up time and, established diagnosis, additional diagnoses, initiated treatment and reported benefit. Results A new diagnosis was established in 13% of all patients. A new treatment was initiated in 56% of all patients: 91% and 51% of patients with and without a new diagnosis respectively (p < 0.001). Of all patients, 19% received an effective treatment (52% vs 14% of patients with vs without a new diagnosis, p < 0.001). Regardless of treatment, resolution or improvement of the chief complaint was achieved in 28% of all patients (52% vs 25% of patients with vs without a new diagnosis, p = 0.006). Regarding diagnostics, 23-33% of radiology, endoscopy and pathology tests performed during second opinion were a repetition of previously conducted investigations. Conventional blood tests were a repetition in 89% of cases. Median time to diagnosis was 64 days (IQR: 25-128 days) and median time to discharge was 75 days (IQR: 31-144 days). Conclusion Second opinions in general internal medicine lead to the establishment of a new diagnosis in a small proportion of patients. However, the value of second opinions may not be limited

Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

“…Other authors reported divergences in 44 % of breast cancer cases and various other ranges likely due to insufficient sample sizes [ 4 , 8 , 10 ]. Some authors reported lower rates of agreement, but mainly in diseases with a predominantly symptomatic presentation such as unspecific pain that may be hard to diagnose and/or treat [ 5 ].…”

“…Higher education status, socio-economic status and female gender [ 5 ] have, to date, been associated to the characteristics of patients that seek an SMO during diagnosis [ 5 , 9 ].…”

Diagnostic Effect of Consultation Referral from Gastroenterologists to Generalists in Patients with Undiagnosed Chronic Abdominal Pain: A Retrospective Study

“…However, because abdominal pain can develop from causes other than gastrointestinal diseases, even after workup by gastroenterology specialists, some patients still require a diagnosis. Since the general internal medicine department is another department where the prevalence of referred patients with undiagnosed abdominal pain is also high [ 2 ], in such cases, a consulted generalist may assist diagnosis.…”

“…In such situations, generalist physicians can assist the specialist to consider abdominal wall pain as a cause of undiagnosed abdominal pain. Indeed, a previous study showed that abdominal wall pain was the most frequently developed diagnosis in patients referred to the general internal medicine department of the university hospital [ 2 ].…”

Redundant laboratory testing on referral from general practice to the outpatient clinic: a post-hoc analysis

“…For patients referred to the outpatient clinic, there are only data on repetition rates in patients referred for second opinions, where up to 90% of laboratory tests were repetitions of tests ordered by the original physician. 13 , 14 Yet no data are available on patients newly referred to the outpatient clinic by their GP. Given the paucity of the data, a post-hoc analysis was performed of a previously published study by the authors on laboratory test strategies in the outpatient clinic.…”