[Limited benefit of diagnostic second opinions in a neurology department]

To describe the short and long term results of neurological second opinions with regard to medical aspects and patient satisfaction.

Prospective observational cohort study

Data regarding medical relevance and patient satisfaction were collected for all patients referred to the neurological out-patient clinic for a second opinion over a period of 6 months. Treating neurologists were asked to fill out a questionnaire to assess the medical relevance of the consultation. Patient satisfaction was assessed using the 'Patient Satisfaction Questionnaire' which was filled out by the patient directly after the consultation and after 2 years follow-up.

183 patients were included during the study period and 78 of these patients returned the follow-up questionnaire. A neurological second opinion led to a different diagnosis in 66 patients (33%). For 42 patients (23%) the new diagnosis had treatment implications. Second opinions were nevertheless considered of low medical relevance by the treating neurologist; the psychological relevance was considered higher. Second opinions led to a short-term increase in patient satisfaction, but after 2 years satisfaction had decreased to the level seen prior to the second opinion. Only 7% of patients indicated their intention to visit another healthcare provider for the same problem directly following the consultation, whereas 2 years later it was found that 30% had done so.

The benefit of second opinion consultations at an academic neurology out-patient clinic was reasonable in the short term, but limited in the long term.