Assessment and second opinion

A structured evaluation by a physician in physical medicine and rehabilitation with the relevant therapists, producing a written report: what the problem is, what is realistically achievable, what programme would achieve it, over what timeframe, and at what cost.

The report is written to be usable by clinicians in your own country. You are not required to have the treatment with us, and the assessment is not structured to lead to that conclusion.

When you have been told nothing more can be done. When you have been offered surgery and want to know whether rehabilitation is a genuine alternative. When a programme has not produced change and you want to know whether the programme or the goal is wrong. When you are deciding between providers and want an independent view of what is realistic.

It is also useful before committing to expensive treatment abroad, including with us.

Imaging and reports, operation notes, discharge summaries, current medication, and previous rehabilitation records. The more complete the history, the more useful the opinion — an assessment based on examination alone misses what has already been tried.

Records can be reviewed remotely in advance, which shortens the in-person assessment and sometimes shows that travel is not necessary.

Including when the honest answer is that a programme with us would not add enough to justify the travel and expense, or that what you need is available closer to home.

We would rather give that answer than take a booking we do not believe in.

The most expensive decision in treatment abroad is made before anyone has examined the patient: whether to travel at all. A written opinion based on the records lets that decision be made with information rather than with hope.

It is deliberately available as a standalone product. You are not required to book anything afterwards, and the opinion is written the same way whether you do or not.

That answer is given when the realistic gain does not justify the travel and cost, when what is needed is available closer to home, or when the patient is not currently in a state to benefit.

It is written down in the same document with the reasoning attached, so it can be taken to another clinician. A service that never produces this answer is not assessing anything.

Usually it confirms it. A systematic review of patient-initiated second opinions found that a second opinion typically confirms the original diagnosis or treatment, yet 10% to 62% led to a major change in diagnosis, treatment or prognosis, and advice on treatment changed more often than the diagnosis 1.

A later review of 33 studies also found that many second opinions confirm the original plan, and that how often opinions differ varies considerably between medical specialties 2. The evidence is limited, and whether the second opinion proved the more accurate one is generally unknown 1. A second opinion tests a plan; it does not by itself show that the new advice is better.