Second opinions and tertiary referrals in neurology

Academic Medical Centre, Dept. of Neurology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Journal of Neurology (Impact Factor: 3.84). 10/2008; 255(11):1743-9. DOI: 10.1007/s00415-008-0019-3
Source: PubMed

ABSTRACT The number of neurological second opinions (SO) and tertiary referrals (TR) is increasing. The main purpose of this study was to assess whether a day-care admission made a meaningful contribution to standard neurological outpatient care, for a wide range of second opinions and tertiary referrals.
All new patients attending an academic neurological day-care clinic in a 6-month period were investigated. Before admission, all previous medical correspondence and ancillary investigations were reviewed. On the day of admission, extensive time was available for clinical evaluation and additional ancillary investigations and an attempt was made to come to a final diagnosis. Demographic characteristics, duration of symptoms, patient satisfaction, new diagnoses and treatment consequences were studied.
300 patients (183 SO and 117 TR) were evaluated. In total 103 patients (35 %) received a new diagnosis (26 % SO vs. 48 % TR, p < 0.001) and 69 (67 %) of these had therapeutic implications. A new treatment advice was given to a total of 149 patients (50 %), which was similar in both groups (48 % vs. 53 %). Second opinions were considered medically less relevant than tertiary referrals (39 % vs. 64 %, p < 0.001). The number of new diagnoses differed largely between various diagnosis categories. Especially somatoform disorders and radicular syndromes were often newly diagnosed.
A high number of second opinion and tertiary referral patients benefits from a day-care admission in a neurological outpatient clinic. Careful selection for referral of patients who will benefit from daycare admission may even enlarge the diagnostic and therapeutic yield.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To investigate whether cancer patients who sought a second opinion received better medical care. Study Design: A total of 1358 newly diagnosed colorectal cancer patients undergoing resection were identified from Taiwan's National Health Insurance Research Database between 2004 and 2008. The frequency of doctor shopping and hospital shopping in the 6 months before resection was used to define "seeking a second opinion." Methods: A generalized hierarchical linear model was used to determine the influence of doctor shopping and hospital shopping on in-hospital complications and prolonged hospitalization after colorectal resection. Results: The risk of in-hospital complications for heavy doctor shoppers was significantly higher than that for patients who were not doctor shoppers (odds ratio [OR] = 1.675, P = .037). However, the risk was significantly lower for heavy hospital shoppers compared with those who were not hospital shoppers (OR = 0.272, P = .007). The frequency of doctor shopping and hospital shopping was not significantly associated with prolonged hospitalization. Conclusions: For colorectal resection patients, the selection of a proper hospital for surgery resulted in better surgical care. The quality of surgical care was worse with heavy doctor shopping. We suggest that healthcare authorities disclose data about the quality of a hospital's cancer treatment to increase patient access to such information. This may help patients find quality healthcare providers more quickly and reduce the waste of medical resources resulting from the long process of seeking medical care.
    The American journal of managed care 05/2013; 19(5):380-7. · 2.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians' attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1) inequalities between central and peripheral regions of Israel; (2) inequalities between private and public settings; (3) implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4) tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient's Rights Law. Further studies are needed to assess the patients' perspectives.
    07/2012; 1(1):30. DOI:10.1186/2045-4015-1-30
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management. Methods Our institutional review board approved the retrospective review of randomized original and second opinion reports for 94 consecutive cases of biopsy proven or clinically suspected head and neck cancer in calendar year 2010. Discrepancy rates for staging and recommended patient management were calculated and, for the 32% (30/94) of cases that subsequently went to surgery, the accuracies of the reports were determined relative to the pathologic staging gold standard. Results Following neuroradiologist second opinion review, the cancer stage changed in 56% (53/94) of cases and the recommended management changed in 38% (36/94) of patients with head and neck cancer. When compared to the pathologic staging gold standard, the second opinion was correct 93% (28/30) of the time. Conclusion In a majority of patients with head and neck cancer, neuroradiologist second opinion review of their outside imaging studies resulted in an accurate change in their cancer stage and this frequently led to a change in their management plan.
    Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 06/2013; 42(1):39. DOI:10.1186/1916-0216-42-39 · 0.72 Impact Factor


Available from
May 22, 2014