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. 2025 Jul 25;15(7):e100287.
doi: 10.1136/bmjopen-2025-100287.

Benefits and challenges of asynchronous telemedicine in obtaining a second opinion: a qualitative interview study

Dunja Bruch  1 , Susann May  2 , Nadja Könsgen  3 , Felix Muehlensiepen  2 , Jan-Christoph Loh  4 , Johannes Maximilian Albes  5 , Sebastian von Peter  6 , Edmund Neugebauer  2
Affiliations

Benefits and challenges of asynchronous telemedicine in obtaining a second opinion: a qualitative interview study

Dunja Bruch et al. BMJ Open. .

Abstract

Objectives: Asynchronous telemedicine-based second opinions, using a purely document-based and written procedure, offer an opportunity to support patients in their medical decision-making, particularly those who cannot secure a timely face-to-face appointment nearby. The aim of the study is to investigate the benefits and challenges of asynchronous telemedicine in obtaining a second opinion and clarify for whom and under what conditions it is suitable.

Design: We conducted a qualitative interview study as part of a larger mixed-methods study. The interviews were transcribed verbatim and analysed using qualitative content analysis.

Setting: Germany.

Participants: The study involved 40 patients (20 women and 20 men) who sought an asynchronous telemedicine-based second opinion via an online platform, predominantly for orthopaedic issues.

Results: Asynchronous telemedicine-based second opinions offer advantages such as access to distant specialists, the ability to consult from home without waiting times, timeliness and a detailed, fact-based report. However, the absence of face-to-face contact presents challenges: it can feel impersonal, technical problems may arise, it can be difficult to articulate symptoms and medical history in writing, and spontaneous interaction or correction is limited.

Conclusions: Under certain conditions, telemedicine-based second opinions can be individualised without face-to-face interaction. Key factors for success include a clear medical question, a well-organised process with good customer support, comprehensive and individualised information, and patient readiness (technical skills, internet access and the ability to articulate symptoms in writing). Major challenges for the German healthcare system include overcoming a potential digital divide as certain patient groups may not be reached by digital services.

Keywords: Health Services; QUALITATIVE RESEARCH; SURGERY; Telemedicine.

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Conflict of interest statement

Competing interests: J-CL is the CEO of Medexo, a second opinion provider. The other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Telemedicine second opinion process.
Figure 2
Figure 2. Potential situations and clients for asynchronous telemedicine-based second opinions.
See this image and copyright information in PMC

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