Diagnostic journeys: characterization of patients and diagnostic outcomes from an academic second opinion clinic

Abstract

Objectives Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford. Methods Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5 year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed. Results Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis. Conclusions A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.

Survey of Inpatient Consultations with General Internal Medicine Physicians in a Tertiary Hospital: A Retrospective Observational Study

“… 26 In addition, although again not limited to inpatients, the Stanford Consultative Medicine diagnostic second opinion service reported that 53% of patients referred for diagnostic purposes had a new single or multi-factorial diagnosis. 27 Compared to these studies, the rate of new diagnoses in this study is comparable, indicating that consultation for DGM for diagnostic purposes is effective. Compared to our previous data on the rate of new diagnoses in outpatients’ consultations with the GIM department by other specialty departments (70.7%) using the same methods for evaluation, the rate of new diagnoses in this study was slightly low.…”