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

Sabrina Chao; Justin Lotfi; Bryant Lin; Jonathan Shaw; Saachi Jhandi; Megan Mahoney; Baldeep Singh; Linda Nguyen; Houssam Halawi; Linda N. Geng

doi:10.1515/dx-2022-0029

Article

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

Sabrina Chao , Justin Lotfi , Bryant Lin , Jonathan Shaw , Saachi Jhandi , Megan Mahoney , Baldeep Singh , Linda Nguyen , Houssam Halawi and Linda N. Geng

Published/Copyright: May 23, 2022

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From the journal Diagnosis Volume 9 Issue 3

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.

Keywords: diagnosis; diagnostic journey; medical mystery; second opinion; undiagnosed

Corresponding author: Linda N. Geng, MD, PhD, Consultative Medicine, Director, Clinical Assistant Professor, Stanford University, 211 Quarry Road, Ste 305, Stanford, CA 94305, USA, Phone: 650-498-9000, Fax: 650-725-7078, E-mail: Geng@stanford.edu

Funding source: Stanford Primary Care and Population Health Seed Grant

Acknowledgments

The authors thank the resident physicians, faculty, and librarians who contributed to the cases. We also thank the Stanford UDN team for review of select cases.

Research funding: This work was supported by the Stanford Primary Care and Population Health Seed Grant.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The Stanford University Institutional Review Board deemed the study exempt from review.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2022-0029).

Received: 2022-03-09

Accepted: 2022-04-19

Published Online: 2022-05-23

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Supplementary Material

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Keywords for this article

diagnosis; diagnostic journey; medical mystery; second opinion; undiagnosed