A Mayo Clinic consultative general internal medicine program changed or clarified diagnoses in 55% of 573 patients with complex medical conditions and modified treatment plans in 82%, according to internal outcomes data reported in a narrative review.
The model provides episodic evaluation for patients with multisystem symptoms, atypical presentations, medically unexplained symptoms, or prolonged diagnostic journeys. Consultative internists review previous evaluations, coordinate targeted testing and specialty consultations, and synthesize the findings into an actionable plan for the patient and local care team.
The Mayo Clinic Center for the Science of Health Care Delivery evaluated deidentified outcomes data from 573 patients seen in the consultative medicine practice during 2024. Investigators reviewed clinical notes across visits to assess diagnostic and treatment outcomes, consolidating repeat visits into a single continuous episode of care. Institutional review board approval was not required because the analysis was considered minimal risk.
A diagnostic change or clarification was defined as any change to the working or final diagnosis or an increase in diagnostic specificity. Overall, 55% of patients met that definition.
Treatment plans changed for 82% of patients. These changes included medication adjustments, new therapies, discontinuation of therapies, and changes in management monitoring. Sixty-six percent of patients had a substantial treatment change, defined as a major change expected to meaningfully affect management, prognosis, or clinical outcomes. The analysis did not establish whether those expected benefits occurred.
Among 49 patients seeking surgical second opinions, 17, or 35%, avoided surgery and instead pursued comprehensive medical management. The authors also reported reductions in hospital admissions, emergency department visits, outpatient visits, and overall health care costs among many patients with high baseline health care utilization, although numerical estimates were not provided.
Extrapolating the observed proportions to approximately 5,000 patients seen by the practice in 2024, the authors projected that about 2,750 had a change in diagnosis and more than 4,000 underwent treatment modification. Patient-reported experience was favorable, with 98% rating the practice a four or five on a 5-point Likert scale and expressing strong confidence in its recommendations.
How the Model Works
Patients may self-refer or be referred by their local care teams, often after specialty referrals have been redirected because of multisystem concerns or an undiagnosed condition. Before the visit, patients complete a questionnaire describing their concerns, priorities, and previous diagnostic testing. A general internist reviews the questionnaire to plan testing and specialty consultations and develop an individualized itinerary.
The episode begins with a 90-minute consultation that includes history-taking, physical examination, record review, documentation, and care coordination. Patients then undergo targeted testing and consultations, with the itinerary adjusted as findings emerge. The consultative internist continuously integrates results to refine the diagnostic approach.
At the end of the evaluation, the internist conducts a summary visit and prepares a document outlining the final diagnoses and specific management recommendations. The summary is intended to help local physicians identify the recommended next steps without reconciling multiple specialty notes. Longitudinal care remains with the patient's primary care team.
The model has also supported focused services, including an Undiagnosed Mass Clinic and a Multicancer Detection Clinic. The authors noted that these tests do not have Food and Drug Administration approval for clinical use.
Limitations
The internal analysis was descriptive and did not include a comparison group. Selection bias was possible because patients at the tertiary referral clinic could self-refer and seek second opinions. Outcomes were assessed only during the clinic episode, and long-term follow-up was not performed after patients returned to their local care teams. The analysis therefore could not determine whether the consultative model caused the reported diagnostic and treatment changes or whether those changes produced sustained clinical benefits.
Conclusion
The authors concluded that consultative general internists can help synthesize complex patient data, guide resource-efficient care, and coordinate diagnostic and treatment plans for local care teams. They wrote that consultative medicine programs remain limited nationwide and could expand access for patients with complex medical conditions.
Disclosures: The authors declared no conflicts of interest and no funding. Grammarly Pro was used for language editing and formatting assistance; the authors stated that they developed and verified the scientific content, analyses, interpretations, and conclusions.
Source: The Permanente Journal
