Outcome of outpatient neurology consultations: physician's evaluations compared to patients' perceptions

The outcome of outpatient neurologic consultations has not been previously evaluated. There is also no data regarding patients' perceptions of outpatient neurologic consultations. In this study, we assessed the physician's evaluations of the outcome and utility of neurologic consultations by reviewing office records of 108 patients referred for consultation to a secondary level neurology clinic. Predefined criteria were used to determine diagnosis and treatment changes resulting from the consultation and the usefulness of the consultation. Outcome was defined as "resolved/improved", "unchanged", or "worse". The patients' perceptions of the usefulness of the neurologic consultations were assessed by a questionnaire survey. The questionnaire evaluated patients' perceptions of diagnosis and treatment changes, outcome and usefulness of the consultation. The physician's evaluation was compared to the patients' perceptions. Neurologic consultations resulted in diagnosis changes in 62% and treatment changes in 85%. Either diagnosis or treatment changed in 92% of consultations, which were regarded as "useful". Seventy-four percent of patients concurred with the physician's evaluation of outcome and 96% concurred that the consultation was useful. Although small, this study found that outpatient neurologic consultations result in diagnosis and treatment changes in a substantial proportion of patients.