[Diagnostic second opinion: what does it add? Patient satisfaction, but diagnosis is rarely altered]

To establish the yield of diagnostic second opinions in patients referred to a general internal medicine outpatient clinic at an academic hospital.

Retrospective cohort study.

Of the patients newly referred to the general internal medicine outpatient clinic at the VU Medical Center, Amsterdam, the Netherlands during 2007, 86 were referred for a diagnostic second opinion. The diagnostic yield was assessed by comparing the outcome of the first and second opinions. To assess patient satisfaction, a telephone survey was held.

There was a difference in diagnostic outcome between the first and the second opinions in 10 of the 86 patients included (12%). A significantly higher proportion of these patients was referred by a specialist, as compared to self-referrals or referrals by a general practitioner. The average satisfaction rate was high in all groups with a statistically significant difference in favour of the group with a different diagnostic outcome after the second opinion. The communication skills of the physician were the strongest determinant for overall satisfaction (r = 0.845; p < 0.001).

In an academic hospital second opinions for diagnostic purposes rarely yield a different diagnosis. Nonetheless, patients are usually satisfied with the process. During referral for a second opinion, care should be taken to avoid creating high expectations regarding a difference in diagnostic outcome.