Guidelines for telematic second opinion consultati

Authors: José PereiraMonteiro MariaMagdalena WysockaBakowska Zaza Katsarava Fabio Antonaci

Publish Date: 2010/08

Volume: 11, Issue: 4, Pages: 345-

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Abstract

The seeking of a second opinion is the longestablished process whereby a physician or expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan Seeking a second opinion has become more common in recent years and the trend is associated with significant changes in the patientdoctor relationship Telemedicine is attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible being impossible or too expensive to reach by any surface transport In Europe the European Headache Federation EHF being able to draw on a group of headache experts covering all the European languages is the organisation best placed to provide qualified secondopinion consultation on difficult headache cases and to develop a Headache Medical Opinion Service Centre The provision of good quality clinical information is crucial to the formulation of a valid expert second opinion This preliminary step can be properly accomplished only by the primary health care provider through the furnishing of an appropriate clinical report together with the results of all available tests including original films of all imaging studies already performed On receiving the EHF’s proposed standardised data collection form properly filled in we may be sure that we have all the relevant data necessary to formulate a valid expert second opinion This form can be accessed electronically and downloaded from the EHF website Once finalised the EHF second opinion project should be treated as a pilot strategy that requires careful monitoring for the first year at least so that appropriate changes as suggested by the retrospective analysis and its quality control can be implementedThe seeking of a second opinion is the longestablished process whereby an expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan A second opinion might be requested by the primary physician primary health care provider PCP by the patient or by the patient’s relatives It serves to reduce uncertainty and thus anxiety and to promote a better understanding of the disease by the patient and her/his family as well as better compliance with the treatment plan When a second opinion confirms the initial diagnosis it may indeed provide reassurance and help the patient to accept her/his disease 1By bridging an important gap between the primary physician’s diagnosis and treatment plan and the patient’s emotional need for expert opinion a medical second opinion should thus help to establish a patient’s medical needs and contribute to achieving optimal treatment goalsNowadays with access to the internet so widespread patients and doctors are directly involved in establishing primary diagnoses and in the treatment decisionmaking process Both categories actively use the internet to get information about a disease and about modern treatment options and strategies and will often actively seek second opinions from opinion leaders in the fieldInitially telemedicine the use of telecommunications technology for medical diagnosis and patient care was mainly used for getting second opinions on imaging data eg radiological and neuroradiological images online ECG USG etc However this novel concept rapidly spread to other medical specialties pathology surgery cardiology dermatology orthopaedics gynaecology urology neurology including neurosurgery and so on 2–4Telemedicine 5 has proved attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible unavailable impossible or too expensive to reach by any surface transport 2 5 6

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