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, 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. The median time to diagnosis was 64 days (IQR: 25–128 days), and the median time to discharge was 75 days (IQR: 31–144 days). Conclusion In conclusion, this extensive research on the outcomes of second opinions in general internal medicine has shown that a new diagnosis is established in 13% of patients. Patients in whom a new diagnosis is established benefit more from second opinions. However, the value of second opinions may not be limited to establishing diagnoses, as patients without a new diagnosis also frequently receive treatment and report improvement of symptoms. Overall, at least 28% of patients benefit from second opinions as resolution or improvement of symptoms is achieved. Whether this is because of the consultation, diagnosis, treatment, or the natural course of the complaint or disease could not be ascertained. Remarkably, a large number of investigations are performed and repeated during second opinions, while these investigations rarely contribute to the establishment of a diagnosis. Despite that, this study has shown that second opinions in internal medicine are valuable in terms of the establishment of diagnoses, initiation of treatment, and improvement of symptoms in a considerable number of patients.
