how to solve a medical problem? · • clinical case compiled • world's top experts found...
TRANSCRIPT
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Our team and experts serve as "medical special forces" for our clients
globally. We view each case as a mission and assemble world's best "medical
navy SEAL team" to fit situation perfectly & resolve it fast
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Our unique value proposition is ability to quickly bring a panel of world's top specialists whose expertise fits
client's situation perfectly – like lock and key. Precise fit = best results.
We do not "sell" you any hospital, region or country. Our experts come from any
clinic, university or city in the world – as long as they ideally and at world-class
level fit all nuances of our client's situation.
We serve as independent trusted advocates for our clients during their entire
journey through healthcare system.
In less than 10 days our experts establish precise diagnosis and best treatment
plan.
We follow up with our clients long-term.
Situations we work with do not have to be traditional "life-or-death" scenarios:
people suffer and die from asthma, syncope, hypertension, seizures, diabetes
and gallstones too…
3
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Why should I care? …Because complex and changing healthcare services leave many patients with wrong or
imprecise diagnosis and cause delayed or inadequate treatment.
link to source
link to source
link to source
Wrong, Imprecise, Incomplete or Delayed Diagnosis
Wrong, Substandard, Suboptimal or Delayed Treatment
• Ultra-detailed definition of disease / therapy
• Discovery that not all diseases need aggressive
treatment (including cancer)
• Multiplication of treatment options
• Physicians have financial conflicts of interest
• Industry conducts total surveillance of each
doctor's prescription records and device use
• Business links may sway clinical judgement
• The state and insurers ration medical care
• Leakage control and gag clauses in doctors'
employment contracts work against patients
• Insurers focus on short term profit and deny
treatments that bring best long-term results
1
Exponentially increasing
complexity and ultra-
specialization in all fields
of medicine
2Tight entanglement between
doctors and pharmaceutical &
medical device companies
3
Strong cost-containment
pressures on those who pay
for healthcare: governments,
employers, insurers
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Patient's typical path through healthcare system – anywhere in the world – is plagued with delays and results in
missed diagnosis and substandard treatment. Medical error is 3rd leading cause of death.
All causes
2,597k
Heart
disease
611k
Cancer
585k Medical
error
251k
COPD
149k
Suicide
41k
Firearms
34k
Motor vehicles
34k
Based on our estimate,
medical error is the 3rd
most common cause of
death in the US
crashing every week
link to source
Causes of death, US, 2013 Patient's typical path through healthcare system:
General
practitioner
• Long wait for appointment
• Zip code lottery re: quality
• Restricted choice of GP
• 8 min "face time" with GP
• GP sees too many patients
• GP has limited knowledge
Suboptimal referral networks:
to "old buddies" & employers
• Not enough time to consider all alternative
symptom explanations
• Mental fatigue: sees too many patients
• Limited experience with patient's disease and
advanced diagnostics
Local
specialist
• Poor fit to nuances of problem
• Wants to treat all patients his own
idiosyncratic way, not best practice
• Biased: will not refer outside employer's
or personal network
• Not on top of latest trends
• Not sub-specialized enough
• Long wait for appointment
Rigid referral patterns, delays,
complex bureaucracy
Regional
specialist
• Financial conflicts of interest
• Enrolls patients into own
clinical trials or "case series"
• Opinion leaders are often in the pocket
of pharmaceutical or medical device firms
• Regional bias in choice of therapy – may be
outdated, suboptimal or discredited option
2 – 4 weeks
another
2 – 6 weeks
another
3 – 6 weeks
Factors with negative influence
on care quality
Causes of errors in diagnosis and substandard
or suboptimal treatment
5
New symptoms
or existing disease
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Regional
specialist
General
practitioner
6
DiagnosticDetectives.Com path leads to correct, precise, complete, and fast diagnosis – with detailed treatment
plan prepared by a panel of world's top experts who precisely fit nuances of client's situation
Our experts speak: Patient's typical path
Local
specialist
New symptoms
or existing disease
2 – 4 weeks
another
2 – 6 weeks
another
3 – 6 weeks
DiagnosticDetective.Com path
• Information intake
• Internal analysis
• Feedback to client
• Clinical case compiled
• World's top experts found
• Case sent for review
• Precise diagnosis & treatment plan
• Follow-up video call with client
• Discussion with client's clinical team
Client contacts
DiagnosticDetectives.Com
0 – 12 hours
12 – 24 hours
3 – 7 days
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• When any serious diagnosis is considered, physicians
must rely on objective tests: MRI, CT, PET, EEG, EKG,
Ultrasound, Laboratory tests, Biopsy, Angiography, etc.
• Even when patient is nearby (same hospital or clinic), staff
doctors make most important decisions about diagnosis
and treatment without patient's presence : Doctors
review cases at conferences, where they spend at most 5
min on each patient's situation.
• All patient data is easily obtained, transferred and reviewed
remotely – whether in the same hospital or across the
world.
• All decisions regarding diagnosis and treatment of heart
disease, cancer, neurology- and neurosurgery-related
problems, autoimmune disease, lung or liver disease,
gastrointestinal, genitourinary problems – even psychiatry-
or child development-related decisions – can be
successfully done from anywhere in the world
7
Healthcare has become а global knowledge industry. What matters for patient is WHO reviews the situation,
NOT WHERE the doctors are located. Important decisions are done without patient anyway
Our experts speak: Does doctor need to see patient in person?
YES NO
• When situation is an emergency
– But at any hospital senior surgeon
"meets" patient only in the operating
room (already under anesthesia)
– Other ( junior) doctors obtain,
structure and report "case" to senior
doctors, discuss case and receive
guidance on treatment options.
…It's how modern medicine works
• When human companionship is a
primary purpose of interaction
– But average MD visit is 10-15 min,
during which patient speaks 4 min
and is interrupted after 12 seconds.
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Generic "best practices" are meaningless: we serve our clients best advice in the world for them.
We create strategic long-term treatment plan with detailed explanations and readily available follow up.
Our experts speak:
Information intake
and expert selection
Experts review
clinical case
Client report
delivered, Q&A
done via audio/
video/email
Long-term follow
up after treatment or
if changes in situation
happen
2 days 3 – 7 days 7 – 10 days
Any time
in future
We quickly identify
several key focal issues of
situation after client
contacts us.
We then find world's top
experts in focal points of
the case – experts can be
anywhere in the world –
and reach out to them
with well-written clinical
case summary
Client gets feedback on
top questions to ask
primary clinical team, key
tests and urgent actions
to do
Experts get precisely
structured written case
and supporting data
(electronically)
Our team does 3-5
iterations of Q&A with
each expert based on
live stream of
information coming
from all experts – this
ensures zero mistakes
Experts review case
independently of each
other or as virtual
multidisciplinary (MDT)
team
Our written report
integrates, references &
provides context to
advice from experts
After client reads our
report, we hold Q&A
teleconference with
client and revert to
experts with more
questions if their input is
required again
We can discuss report
and expert views with
client's local clinical
team. We complement,
not supplant local MDs
Once top experts know
client's situation they
can follow up fast if
things change
We work with client's
local clinical team to
ensure strategic
diagnostic and therapy
plan is followed and
patient is treated locally
or regionally
If client is not happy
with primary clinical
team, we help to find
new team at location
convenient for client
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"Our mission is simple: to lead people to full and long-lasting health"
– Anton Titov, MD, PhD, MBA (Founder)
Dr. Titov on important questions to ask: Dr. Anton Titov has top international clinical, research and business experience
Experience:
• Neurological Surgery Resident at Brigham and Women's Hospital and Children's Hospital Boston (major
teaching hospitals of Harvard Medical School)
• Research Fellow in Neurology at Children's Hospital Boston and a Research Fellow in Medicine at Beth Israel
Deaconess Medical Center Boston (Harvard Medical School)
• He also worked at Goldman Sachs investment bank in London and Munich-based TVM Capital
"I have founded this venture after deeply personal experience with seeking the best options for my elderly
mother's heart valve problem and then for her rare lung tumor treatment.
…I realized that even having access to and deep knowledge of the world's best hospitals does not guarantee
the best solution for any given problem. You have to find a specialist whose expertise fits perfectly all nuances
of patient's situation – like lock and key…
Two doctors in the same specialty – working at the same hospital at the same level – can have a vast difference
in knowledge of treating a given problem. Choosing suboptimal expert could be a fatal mistake. But perfect
expert can establish precise diagnosis and offer the best possible treatment plan even in the most challenging
situation. Today treatment methods are standardized – local team can fulfill them anywhere in the world.”
Education:
• MBA, Harvard Business School
• PhD in Molecular and Cell Biology, The Rockefeller University (laboratory of Dr. Günter Blobel, who was
awarded – as a single recipient – Nobel Prize in Medicine)
• Harvard Medical School: rotations at Massachusetts General Hospital's Cancer Center, Lown Cardiovascular
Group, and Neurosurgery department of Brigham and Women's Hospital
• MD, St. Petersburg Medical Academy. He also studied mathematics at St. Petersburg University
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Our Expert Advisory Board includes world's leading physicians and surgeons from top universitiesSee link for profiles & videos
Dr. Roc Chen
Neurosurgery
Texas / Harvard
Dr. Arthur Day
Neurosurgery
Texas / Harvard
Dr. Lawrence Cohn
Cardiac Surgery
Harvard / Stanford
Dr. Philip Darney
Gynecology and Obstetrics
UCSF
Dr. Robert Lustig
Endocrinology
UCSF
Dr. Eric Woodard
Neurosurgery
Harvard
Dr. Sam Shen
Emergency Medicine
Stanford
Dr. Simon Robson
Gastroenterology
Harvard
Dr. Kent Yucel
Radiology
Tufts / Harvard
Dr. Aric Parnes
Hematology
Harvard
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Our clients: “There's nothing quite like it to have a team of people so focused on you, trying to get to the
bottom of what your problem is...”
"I wouldn't think twice about recommending you or using the service again any time in the
future. Thank you for helping us!"
Our clients speak:
“My close relative received cancer diagnosis. We first followed a standard path, but everything
was done very slowly... Is the diagnosis correct? Is there anything forgotten?"
"I think second opinion is always required… My advice is to get second opinion as early as
possible... When problem is found - ask for expert opinion..."
“It was like having the whole team that works with Dr. House - all working together, trying to
find out what we should be doing next..."
"There's nothing quite like it to have a team of people so focused on you, trying to get to the
bottom of what your problem is..."
"After we used your services we got confidence that you use the latest knowledge, that you are
positioned at the cutting edge of medical science..."
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Our clients: “It's not always possible to reach out and communicate with such specialists and it's impossible to
find them on your own - here your help was most valuable...”
Our clients speak:
"Thank you very much, I am glad I got your help!"
“When I consulted your expert I learned there are other solutions for my problem. ...that I could
with confidence avoid taking anti-epileptic medications during my pregnancy"
" When you have complete information about how to deal with your problem, your feel more
calm, you feel better... Here your help was most valuable!"
“In the first few minutes I was really shocked to hear words ‘heart attack’. During first hour I
could not understand what to do... It was a real shock for me..."
"I considered myself, first of all, too young to think about any heart disease whatsoever. If I
had any idea that something is wrong with my health I would have gotten as much information
as possible about where I could get help to avoid any problems in the future "
"Doctors who have just one type of knowledge also have one type of opinion... Specialists with a
different experience can show you another point of view about your situation...."
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Our clients: “Online transfer of medical information to you is very convenient... you get a fast response from top
specialist whether additional tests are needed... And you can do them anywhere in the world”
"I work at top international management consulting company, I studied in the US, UK and
France. I would highlight three aspects of your service: convenience, speed and precision"
Our clients speak:
”Second opinion is always applicable, it's a standard practice today. Second opinion allows to
make sure that diagnosis and the choice of treatment is correct. Thank you very much!"
“Last year my father was taken to hospital because his heart and his breathing stopped. We
wanted to know how to establish a definitive diagnosis and best long-term treatment"
"Thank you very much for your help and for your contribution to helping my father regain his
health and to give our family peace of mind!"
"You select experts who really know the details of the question. Your experts have large
experience - and do key research - in exact area of the problem. "
"Unfortunately today patients often do not get specific long-term plan... Doctors often rush
patients out of the door. Your expert report gave us strategic, long-term plan of action..."
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Our offer for employers: for every employee we will solve any medical challenge to world's best standard.
There are no hidden charges. Full transparency and control over costs guaranteed. Keep your insurance.
Offer our service as a perk for your staff
and their family members
You will win:
Your employees will
1. …put more time into work instead of
chasing wrong solutions to medical
problems;
2. …have better mental focus on work instead
of being distracted by worries a medical
situation at home always brings;
3. …become more loyal to your firm and
grateful to you for life.
We work anywhere in the world. Contact us to
discuss corporate service contract today:
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Appendix 1
Why our approach to solving
medical problems is superior
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Precise matching of experts to nuances of client's problem is critically important for making correct, timely,
precise and complete diagnosis – and for crafting perfect plan of treatment
Our experts speak: Precise fit of expert's research & clinical focus to nuances of
patient's problem is a key determinant of best therapy plan
We select experts globally – from any clinic, hospital, university, city,
region, or country
• "How well does this expert's knowledge fit all nuances of client's
problem?" This is our only expert selection criterion
• Two doctors in same specialty at the same hospital can have huge
difference in knowledge & experience for specific situation, but
patients cannot discern such hidden but critical differences
• We do not "sell" any specific clinic, hospital, city or country
• We have access to all top experts in the world in all specialties
• All our experts have stellar international academic reputation
Team of
world's best experts
for this particular patient
reviews and advises
on each case
Experts from different regions or
countries review each case
• Unbiased, international,
multi-faceted review is key
• All experts review each case
independently of each other,
or as a virtual team
• Conflict of interest is huge &
growing problem in healthcare
• Remote opinion is often just
a sales channel for hospital's
lucrative medical services
Our experts have no conflicts
of interest to serve our clients
16
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Only experts who spend a lifetime – at world's top level – studying and treating precise problem the patient is
facing can pick up nuances of situation and provide the best, long-view advice on treatment
Our experts speak: Precision in diagnosis
drives precision in
treatment and gives
certainty in prognosis
Medicine has become
Personalized, Predictive,
Preventive, Participatory
("4P Medicine")
What was once considered
a single disease – for
example, "cancer of organ
X" – turns out to be many
different diseases. But
which one does this
patient have?
Adding one drug to
regimen today can prevent
relapse many years from
now
40% of established clinical
practices are harmful or
ineffective
22% of cardiac pacemakers
are implanted unnecessarily
>20% surgeries not
necessary
Only 2% of patients
required restarting drugs
after 5 drugs were stopped
in 90% of them
30% FEWER patients die
when senior doctors LEAVE
the hospital for a
conference
$750 billion / year is spent
on unnecessary healthcare
in US
Great contradiction
of modern medicine
To a hammer, you will
always look like a nail:
surgeons want to cut,
doctors – to give pills,
radiotherapists – to irradiate.
Your GP probably wants to
wait…
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Our method of selection of experts whose lifetime of clinical and research focus fits our client's situation
PRECISELY is a key reason for superior and fast results we deliver to our clients around the world
Our experts speak:
Information intake & our
MD team analysis
Global search
for best-fitting experts
Several iterations
of case discussion with
experts,
MD-to-MD
Selection of 3-5
ideally fitting experts
for detailed review
12 hours 24 hours 36 hours < 2 days
1. "Harvard-grade"
MD case runners
compile & analyze
available client info
2. Key focal areas of
case form the basis of
around-the-world
search for best
experts for client’s
specific situation
3. Internal team
prepares detailed,
highly structured
written "case"
according to top US
academic hospital
standards
1. Algorithm-based
search of global
medical literature,
conferences and
professional
networks to compile
shortlist of world's
top experts in key
focal areas of clinical
case
2. Input from our
Expert Advisory
Board (top doctors
from Harvard,
Stanford, UCSF,
Texas, Europe)
1. Short summary of
case circulated to
shortlisted experts
2. 99% of experts give
us feedback in <12
hours on suitability
& time to review of
complete case
3. "Pre-review" of each
case with top experts
ensures perfect
"expert fit" and helps
to avoid diagnostic
mistakes
4. All experts are 100%
free from conflicts of
interest to serve our
clients
1. Experts typically
have 20 – 40 years
of experience and
200 – 400 peer-
reviewed papers in a
focal point of case
2. Detailed written
structured case and
supporting imaging
data provided to
panel of experts
3. Experts review case
independently of
each other or as a
virtual panel
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Our method of communication with experts serves clients the best: we efficiently present situation to experts
and ask all questions client asks + all questions that SHOULD BE ASKED. And we get answers fast.
Our experts speak: Client Our MD Team Expert panel
• Experts we work with are
at very top of their
specialty and very busy
in clinical & research work
in their hospitals.
• Experts work with us
because we use highly
efficient and structured
MD-to-MD discussions
• These experts will NOT
engage in inefficient
discussion methods
directly with clients
(videoconference, audio
or email exchanges)
• Our MD case runners are
trained at top US
hospitals to prepare and
discuss clinical cases
• We provide fast initial
feedback to clients: e.g.,
what to ask doctors?
which tests to do?
• We communicate with
clients regularly, as new
information comes in
• We prepare written report
and answer all questions,
with further expert input
if required
• Transfers to us available
information. No extra
medical tests required.
• Gets fast feedback and
regular updates on key
issues of situation
• Receives detailed written
report from us, followed
by video- or audio-
conference, email or live
chat exchange to answer
all questions
• We can talk to primary
clinical team directly
Live video-conferences and direct expert-client exchange are inefficient: scheduling conflicts
and meandering conversations preclude top experts from direct client contact.
Only less qualified or underemployed doctors do live audio / video calls
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Experts we find are perfectly positioned to weigh all options in a fully informed, transparent, unbiased
way – because we find experts GLOBALLY and match them IDEALLY to nuances of client's medical situation
Our experts speak: World's top experts help our clients answer life-altering questions, for example:
• How to weigh between several new complex treatment options for autoimmune disease?
• Should I switch to new highly effective multiple sclerosis drug that has rare but fatal side effects?
• Should I use gamma knife or surgery for my acoustic neuroma? Or combination? Which to do first?
• Should I have a coronary artery stent placed or continue with medical therapy for angina pectoris?
• Should I take these medications during pregnancy? Should I deliver baby by Cesarean section?
• Will I be OK with local surgeon or should I seek international expert for this condition?
• How can I get 100% confidence that my treatment is on par with world's best and latest practices?
• Should I choose active observation, surgical resection or radiotherapy for local prostate cancer?
B
Treatment options are often
known. But how to weigh
correctly risk factors and
long-term outcomes of
treatment? How to choose
between many surgical and
medical therapy options?A
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Our 3-5 member international expert panels consider ALL diagnostic and treatment options – AS THEY RELATE TO
CLIENT'S SPECIFIC SITUATION – and distill them into written strategic treatment plan, with explanations
Our experts speak: Questions our precisely-matched expert panels answer:
• Is my diagnosis correct? Is my diagnosis precise? Is my diagnosis complete? *
• Doctor said I only have options A, B, or C. Is that all I have? [options D, E+F or "K after C" may exist]
• Many treatments are now standardized – but which protocol among a dozen options is best for me?
• Is there a treatment option out there that my doctor does not know or does not tell me about?
• How to find the best surgeon for treatment option X? Or specialist for alternative medical therapy Y?
• What other risks to my health does this diagnosis imply? [Problems in separate organs could be linked via
common gene mutations – like breast and uterine cancers, or autoimmune problems]
* Many existing diagnostic categories are too broad and outdated. For example, defining cancer diagnosis by organ of tumor origin
and presence of metastases is not enough anymore. What are specific mutations in tumor and in patent? Tumor gene expression profile?
Availability of experimental therapy? Which clinical trial to enroll, among many? How to prevent relapse years after treatment?
DiagnosticDetectives.Com
3-expert review panel
Our experts give client 100%
confidence in diagnosis and
provide strategic treatment
plan, which almost always can
be fulfilled by local doctors…
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Need surgical operation? Surgeon is the most important prognostic factor in your treatment. Choosing the right
surgeon matters even more than you know. We help to find best-fit surgeon for any situation.
Our experts speak: In emergency, you don't get to pick your surgeon. But for elective operations, it is much more
important to pick the right surgeon than "good" hospital.
Surgeons with high complication rates work even at best academic medical centers anywhere
The difference between the most skilled and least skilled surgeons is remarkable.
Landmark study compared top 25% to bottom 25% of bariatric surgeons by skill.
These results are relevant for any kind of surgeon:
• Least-skilled surgeons had 3x more complications
• Least-skilled surgeons took 50% longer to do same operation, creating more risks for patient
• Least-skilled surgeons might have up to 40 times higher death rate
“Hospital's own medical systems do not weed out poorly-performing surgeons. Peer review is not
effectively protecting patients from incompetent physicians" – Robert Oshel who ran US federal
database of doctor discipline, National Practitioner Data Bank, used by employers
Surgeons who do more operations of given type have much better results. For example, 30-day
death rate after resection of pancreas was 4x lower among "high-volume" surgeons.
"Experience of surgeon is not everything. Knowledge is the most important thing. Some surgeons are
very experienced but they do the operation in a wrong way"- Top cancer surgeon
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Is it "second opinion"? Yes and No: we have evolved to be "First Opinion" – full advocates for our clients on their
journey through healthcare system. We help clients navigate complex and arcane medical world.
Our experts speak:
Second Opinion Letter
…is typically a 1,5 page letter from a doctor
selected in nontransparent way, by unclear
method, and often for tenuous reasons.
Physicians providing "second opinion" often
have conflicts of interest, administrative or
long-term financial ties with those who
commission their views on situation. Often,
they are poorly matched to nuances of case.
Typical second opinion letters are brief, lack
background analysis and context, answer just
a few of patient's questions (which might not
be most critical questions this patient should
ask), and often have condescending or
dismissive tone towards local team treating
the patient.
- Such letter has limited value for patient
Dr. X
Some HospitalDiagnosticDetectives.Com
Client Research Report
…is 10 – 30 pages long, presents
analysis of every aspect of case by a
panel of 3 – 5 top global experts
precisely matched to nuances of
client's problem in transparent way.
We provide full background, context,
discussion, and references to expert's
views and advice. We follow up with
client during and after engagement
and we can interact directly with local
clinical team and other carers.
- Our report provides long-view,
strategic value for our clients
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DiagnosticDetectives.Com radically and favorably differs from all other "remote opinion services": our experts
always perfectly fit each client, we are very efficient and 100% free from conflicts of interest
Our experts speak: Most "expert opinion providers" have conflicts of interest and lack
knowledge or incentives to serve patient's interests well
"Brand Name Big
Hospital X"
• Limited expert selection: only hospital's own staff, often junior or less busy
• Doctor's suave looks and trendy office does not equal true fit for case
• Biased: purpose of "expert opinion" is to sell hospital's lucrative services
• Black box: patient dumps data via web portal – no transparency or control
• Mediocre result: 1,5 page letter answering a few questions, no follow up
• Conflict of interest: primary business goal is short-term cost control
• Conflict of interest: strong incentive to justify treatment methods it pays for,
whether or not they meet or exceed standard of care for patient
• Not interested in ideal expert-problem fit: cases sent to affiliated doctors
Insurance
Company Y
• No real expertise in expert selection or case management
• Primary goal is to entice patient to spend money at its affiliated hospitals
• Owned by or informally affiliated with hospitals it sends patients to
• Fee is a cut from patient's bill: steers patient to most expensive treatment
"Medical Tourism"
website or company
• Cost-cutting is primary goal: usually achieved via rationing of care
• Complete disorganization at all clinical and administrative levels
• Restrictions on patient's ability to seek unbiased top expert advice
• Elites avoid state-run care or use administrative power to cherry-pick
Government-run
healthcare system
Who claims to offer
"second opinion"?
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Appendix 2
What most people don't think about – but should
– when dealing with a medical problem
Most information in this series of slides comes from sources in the US, UK and Western Europe –
because healthcare in these countries is regulated, analyzed and discussed to greatest extent
However, this information is at least equally relevant to all other countries
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Timely access to care is a global problem. Delays in diagnosis and treatment lead to poor clinical results.
First number is wait time in days to see specialist in
cardiology, dermatology, orthopedics, OB/GYN
Second number is wait time in days to see a
family practice physician (GP)
link to source
Long wait times for doctor appointments are a global problem:
• 9.5 weeks is average time a Canadian waits to see a specialist
• At least 50% of patients wait more than 4 weeks for specialist appointment in Norway,
Sweden, France, Australia, New Zealand
• Wait times and shuffling of patients between hospitals is one reason why in Denmark
cancer survival is one of the worst in Europe
Patients waste 2 hours to get a 20 min appointment with doctor:
"Time spent per year by employed adults seeking medical care exceeded the number of
annual hours worked by more than 500,000 full-time employees and the opportunity costs
are greater than $50 billion a year."
– Dr. Ateev Mehrotra / Harvard Medical School
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Doctor spends 8 minutes of face time with patient during 15-minute visit. It's medical speed-dating, not a
patient-doctor relationship. Rush and mental fatigue lead to missed diagnosis and wrong treatment.
Link to source:
"Why your doctor has no time to see you"
– Dr. Bodenheimer
Medical foundations advise patients to plan visit to doctor by each minute
Doctor interrupts patient after only 12 to 23 seconds of patient's speaking
Average duration of visit to physician is about 15 minutes, according to different studies,
during which actual patient-doctor interaction is less than 50% of visit duration
Doctors spend 1.3 minutes explaining main issue to patient in technical language, but self-report that they
spend 8 minutes, so the table below likely overestimates duration of GP appointment
Doctor spends 5 minutes on the longest topic whereas the remaining topics each receive 1.1 minutes. "Length
of the visit overall varied little even when contents of visits varied widely"
Visit duration according to visit type, in minutes
New patient visit to GP Routine visit to GP Full physical examination, GP
USA 32 18 36
Germany 16 6 12
UK 11 10 20
link to source
34% of time doctors forget or lose track of potentially important things the patient says
40% of doctors think it's the patient who should keep most accurate & complete patient records
Surgeons spend 4.3 minutes with new patients and 3 minutes with follow-up patients (UK data)
"When you have only 15 minutes per patient,
then there are home visits and hospital visits,
you feel like you're on a hamster wheel,"
"I was a full-time primary-care doctor for more
than 30 years. It almost killed me."
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Deadly cost of delays in correct diagnosis and care – an example: UK has lower incidence of cancer but worst
survival in Western Europe. NHS wait times are long, 23% of cancers are diagnosed as emergency.
Global cancer rates
link to source
The ten worst countries and the UK cancer
rate, per 100,000 of the population
314.1
326.1
France
Czech Republic
Belgium
New Zealand
Norway
Canada 296.6
309.2
300.2
300.4
306.8
299.1
317.0
295.0
Denmark
Ireland
UK 266.9
Australia
US
SOURCE: World Cancer Research Fund
UK's NHS is a state-run healthcare. Some reasons why NHS is behind in cancer treatment:
• Long delays at every step of patient's journey from cancer suspicion to definitive treatment
• Lack of personal responsibility of doctor for patient. In NHS, a "ward team" of many doctors is collectively
responsible for 10-20 patients in the ward, so no-one is directly responsible for anyone. This leads to lack of
intimate knowledge of patient's situation, confusion in care, and delayed decisions.
• Conflict of interest among NHS consultants, who "moonlight" privately at the expense of NHS work
• Rationing of care by NICE, age discrimination and discouragement of patients to seek second opinions
Such patients are 2x as likely to die
within one year after diagnosis…
link to source
link to source
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It's not just cancer. Wrong diagnosis and wrong treatment affect millions of patients with many diseases:
multiple sclerosis, epilepsy, heart attacks, asthma… The cause is delayed & poor specialist attention.
Death in the United States
48,146
Flu/pneumonia 55,227
76,488Diabetes
Alzheimer’s 93,541
Kidney disease
136,053
Respiratory disease
Accidents
42,773Suicide
Stroke 133,103
591,699
147,101
Cancer
614,348Heart disease
Medical error 251,454
SOURCE: World Cancer Research Fund link to source
Johns Hopkins University researchers estimate that medical error is now the
third leading cause of death. Here's a ranking by yearly deaths.
Some estimate 400,000
deaths per year are due to
"preventable harm"
• 55% of the population of adults in the UK receiving treatment for epilepsy have
never received specialist advice
– 20% to 30% of epileptics may have been misdiagnosed – they have heart
problem instead of epilepsy. Alternative diagnosis was found in 42%
• More than 1 million people in UK may have been wrongly diagnosed with asthma.
UK state agency says up to 30% of the 4.1 million people treated for asthma show
no 'clear evidence' of having asthma
• 80% of multiple sclerosis (MS) sufferers in UK are misdiagnosed. 39% of people with
MS are waiting over a year for correct diagnosis.
– Famous BBC Journalist Caroline Wyatt "had been struggling with undiagnosed
symptoms for 25 years but was only diagnosed with MS after she was paralyzed
down her left side."
– Most multiple sclerosis patients in UK are "receiving inadequate care",
60% are not prescribed correct medications, even though drugs are available.
• 30% "given wrong initial heart attack diagnosis"; women suffering heart attack were
2x more likely than men to have incorrect initial diagnosis
– 87% of heart attack patients did not receive one or more internationally agreed
recommended interventions. 30% of deaths (33,000) "may have been prevented
over 10 years if all best practices were followed."
• 63% of ovarian cancer patients in the US receive inadequate care
THE WASHINGTON POST
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Doctors are not infallible. Personal problems can and do affect clinical skills and judgment
30
Medical errors are 3rd leading cause of death in the US (and likely everywhere). Error of diagnosis is the most
common and deadly type of medical error – yet it is the least studied medical error type.
There are 3 types of diagnostic errors:
Why Diagnostic Errors Occur?
Major diagnostic errors are found in 20% of autopsies = 80,000 patients die annually in the US from
diagnostic errors. The Institute of Medicine reports that 1 in 10 diagnoses are incorrect.
• Complexity of the diagnostic process – There are 10,000 diseases and 5,000 laboratory tests. But
there are only a small number of symptoms, so any one symptom may have dozens or hundreds
of possible explanations.
• Complexity in health care delivery – Healthcare systems link together hundreds of different
processes, practices, procedures and technologies. They grow more complicated by the day.
• Cognitive errors – Doctors are human and make the same mental errors we all make. Sometimes
we don't notice a key finding, or misinterpret what was said. We think we've made sense of the
situation, but we're wrong.
a patient whose medical complaints are never explained.
(example) patient is having a heart attack but is told their pain is
from acid indigestion.
the diagnosis should have been made earlier. Delayed diagnosis of
cancer is by far the leading entity in this category. There are many
causes for this delay.
• Missed diagnosis
• Wrong diagnosis
• Delayed diagnosis
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Diagnostic errors are more common, costly and harmful than treatment mistakes. Error of diagnosis is also the
most preventable medical error, from a patient's perspective.
link to source
"Everyone will experience one meaningful diagnostic error in their lifetime" – diagnostic errors
affect at least 12 million adults in the US each year
"Diagnostic errors will likely worsen because the diagnostic process and the delivery of health
care become more complex" – Institute of Medicine report on diagnostic errors
28% of diagnostic mistakes reported anonymously by doctors were life-threatening or had
resulted in death or permanent disability
"Misdiagnosis happens all the time. This is an enormous problem, the hidden part of the
iceberg of medical errors that dwarfs other kinds of mistakes," said David Newman-Toker,
professor at the Johns Hopkins School of Medicine
No one knows how many people suffer from misdiagnoses or delays that affect their care.
"Despite their prevalence and impact, diagnostic mistakes have been largely ignored"
Diagnostic errors are more common in outpatient settings - most frequent type of visits
"Treatment starts with diagnosis. If you don't get the diagnosis right, you can't get the
treatment right. And yet no one is working on it."
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Diagnostic errors are difficult to discover. They are often hidden from views of both patient and doctor.
"Doctors often don't know when they have made the wrong diagnosis. If a doctor
misses something and another one figures it out, the first doctor often never hears
about it."
"Diagnostic mistakes have been long ignored: They are regarded as an unusually
personal failure in a profession where diagnostic acumen is considered the gold
standard."
"A hospital could earn performance incentives for giving all of its patients diagnosed
with heart failure, pneumonia and heart attack the correct, evidence-based and prompt
care — even if every one of the diagnoses was wrong."
"Diagnosis is hard. It's complicated. It happens under quite a lot of uncertainty and time
pressure. Diagnostic errors are harder to catch than medication and surgical errors
because there's often a lag before it's clear the mistakes have occurred."
"The data on diagnostic errors are sparse, few reliable measures exist and often the
error is identified only in retrospect. That's because it's hard to measure these mistakes.
Sometimes that only happens after autopsies, or as a result of medical malpractice
suits."
– John R. Ball, vice president of the American College of Physicians
DiagnosticDetectives.Com
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Diagnostic errors have many causes. Missed, delayed and wrong diagnoses are not just doctor's individual fault
– diagnostic mistakes also result from complexity and bureaucracy of modern healthcare systems.
Some causes of diagnostic errors
Our work flow and precise fit of experts to nuances of client's problem removes all of them
"Doctors don't get paid for
talking to each other. Our
system prevents the doctors
from talking to each other."
Flawed ways of thinking coupled
with negligence
Differential diagnosis is
inadequate in 80% of cases
Clumsy health information
technology is a "barrier to good
health care…
"Overconfidence in our abilities is
a major problem.
Physicians don't know how error-
prone they are."
…because information isn't easily
accessible and is often presented in
a confusing manner"
Failure to ask "What else could this
be?" can cause premature fixation
on the incorrect diagnosis
"negligence was highest for
diagnostic mishaps"
Poor coordination of care
Limited feedback about the
accuracy of diagnoses that
physician previously did…
Over-diagnosis
Complexity of care
Heavy bureaucracy
"Physicians today spend so much
time filling out forms, seeking
approvals and ordering things –
you can't increase work pressure so
much without expecting errors to
increase."
"They might not define that as
an error. But I think the task of
addressing over-diagnosis is
critical." …No single physician can figure
out which tests do I use on this
particular patient."
The health-care culture
discourages transparency
and disclosure of errors.
"There are 30,000 diagnostic tests
and 10,000 of those are molecular
tests…
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Diagnostic errors are the main cause of paid malpractice claims.
Patient's death is twice more likely to result from error of diagnosis than from other medical mistakes.
link to source article
"Diagnostic errors are most common, most costly and most deadly of all medical errors"
Diagnostic errors are the main source of successful malpractice claims – and not surgical
misadventures, obstetrical mistakes or improperly delivered medications.
In 41% of diagnostic error cases the patient died, compared with 39% for medication errors and 26%
death rate for treatment errors.
Diagnostic errors cost $38.8 billion in malpractice claim payouts over 25 years in the US.
Incorrect, missed or delayed diagnoses accounted for 29% of successful malpractice claims. They
accounted for 35% of the total amount of money paid out.
Diagnostic error claims were more common in outpatient care than hospital care (69% vs. 31%) but
hospital inpatient diagnostic errors were more likely to be lethal (48% vs. 37%).
In other countries, where medical malpractice law is not developed, most medical errors remain
invisible and silently ruin lives of families. Same is in the US when not enough money is at stake.
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Conflicts of interest among doctors is a huge problem. Conflicts of interest directly affect physician's clinical
judgment and choice of treatment options for patients.
link to source
"For a physician, working with Pharma is akin to
getting pecked to death by a flock of ducks," Zephyr
CEO says. "Do you want nine salespeople queued
up to call on you?" link to source
"Conflicts of interest are real, and they are still
influencing decisions from the level of the patient
all the way up to national health policy.
link to source
"The pharmaceutical industry has corrupted the practice of medicine through its influence over what
drugs are developed, how they are tested, and how medical knowledge is created"
- Harvard University Center for Ethics report
"Doctors who have a financial interest in radiation treatment centers are much more likely to prescribe
such treatments for patients with prostate cancer" – US Congress investigation
Doctors who have financial interest in MRI equipment send 30% more patients to do MRI.
Surgeons may prefer to implant into patient those brands of devices, where surgeon receives a cut of
revenue from "selling the device" to patient – US Justice Department / WSJ report
Physicians' prescription patterns are closely tracked by pharmaceutical companies and heavily
influenced by Pharma representatives, who rarely inform doctors about serious adverse events
Top 5 doctors earn between $20 and $44 million per year from pharmaceutical companies
State-funded healthcare systems create incentives to under-treat, rather than over-treat patients
"Imaging self-referral, whereby a non-radiologist physician refers their own
patients for imaging to facilities in which they or their partners have a
financial interest, is a growing trend in medicine"
– Radiological Society of North America
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Many surgical procedures are unnecessary. 40% of established medical practices are useless or harmful.
link to source
To watch this video report from US PBS, you need to
be in the US, or use VPN and point VPN to the US
server location. You can use Opera browser with easy
free built-in VPN: opera.com
Money in Medicine:
video report
When "top doctor" is away
from the hospital – attending a conference – heart
attack patients die 30% LESS OFTEN
as unnecessary interventions are NOT done
link to source
Financial incentives drive physicians and their corporate employers to do unnecessary procedures in
all fields. Examples in: dermatology, cardiac surgery, coronary artery stenting
30% of all laboratory tests are probably unnecessary – Harvard Medical School study
30% to 70% of all surgical operations around the world are unnecessary
Unnecessary procedures are an international problem:
• In some regions of the UK, up to 50% of coronary interventions and bypass grafting are done for
inappropriate reasons. On average, about 20% of coronary interventions are unnecessary.
• In Israel, 29% of gallbladder removals were done for "less-than-appropriate reasons"
• In Sweden, 19% of referrals for coronary artery revascularization were inappropriate
• Most surgical repairs of knee meniscus are unnecessary, study in Finland finds
Hospitals profit from surgical errors, getting $30,000 more from a patient with complication
40% of established medical practices are harmful or useless, in 22% benefits are unknown,
and only in 38% scientific review reaffirmed benefit of established medical practice
Majority of unnecessary procedures are almost never discovered or questioned, rarely are
some doctors prosecuted when fraud becomes too egregious
23% of cardiac pacemakers are implanted unnecessarily
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22.5%12%
37
Examples of unnecessary surgical and diagnostic procedures (1 of 2) Link to source
link to more information
of all
angioplasty
procedures
were not
medically
necessary
CARDIAC ANGIOPLASTY, STENTS
A 2011 study looked at angioplasty
procedures, which often include insertion of
stents, in cases where patients were not
suffering acute heart attack symptoms.
"The procedure has been proved to prolong
life only in people highly susceptible to heart
attack. In everyone else, it appears only to
ease angina. Further, the procedure has risks,
including heart attack, stroke or death."
- Consumer Reports, 2005
Source: Journal of the American Medical Association
CARDIAC PACEMAKERS
А 1988 study reviewed 382 pacemaker
implants at 30 Philadelphia-area hospitals,
finding 20% of the procedures were not
medically warranted. A 2011 study reviewed
records for 112,000 patients who had an
implantable cardioverter-defibrillator (ICD), a
pacemaker-like device that corrects heartbeat
irregularities.
link to source
Sources: New England Journal of Medicine, Journal of
the American Medical Association
of the
cases
showed no
evidence to
support the ICD
installation
had been told
they needed
surgery, but had
no neurological
or radiographic
findings that
indicated an
operation was
necessary
BACK SURGERY, SPINAL FUSION
Another 2011 study evaluated 274 patients
with neck and back complaints over a one-
year period.
"Since the 1980s, operations for low-back
pain have increased from about 190,000
to more than 300,000 per year. Many of
those operations are probably unnecessary."
- Consumer Reports, 2005
Source: Surgical Neurology International
COLONOSCOPY(Removal of colon polyps/screening
for colon cancer)
А 2011 study looked at 24,000 Medicare
patients who had a normal colonoscopy and
found that 46% had a repeat of the
procedure within seven years, despite
medical guidelines stipulating that the
interval should be 10 years. Among those
who had the second procedure early.
Source: Archives of Internal Medicine
had no clinical
indication that
there was any
clinical need
link to more informationlink to more information
43%17%
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Examples of unnecessary surgical and diagnostic procedures (2 of 2)
who got
information
had fewer
knee
replacements
Sources: New England Journal of Medicine, Journal of
the American Medical Association
HYSTERECTOMY(Surgical removal of uterus)
In a 2000 study, researchers assessed the
appropriateness of hysterectomies in 497
women from nine managed care
organizations in Southern California.
The conditions that most often cause pelvic
pain or abnormal bleeding — fibroids, or
benign tumors; endometriosis, or growth of
uterine-like tissue on abdominal or pelvic
organs; and hormonal imbalances — can all
be treated less aggressively."
- Consumer Reports, 2005
Source: American College of Obstetricians and Gynecologists
of these procedures
were recommended
inappropriately, often
because doctors didn't
attempt treatment
with non-surgical
approaches
who got
information
had fewer hip
replacements
TOTAL HIP REPLACEMENT
In the same Washington state health system
study Involving "health aids," researchers
found:
Source: Health Affairs
CESAREAN SECTION
In a 2013 study, using data from 593
hospitals nationwide, researchers found that
cesarean rates varied tenfold across hospitals,
from 7.1% to 69.9%.
"Vast differences in practice patterns are
likely to be driving the costly overuse of
cesarean delivery in many U.S. hospital," the
study concluded.
Source: Health Affairs
C-section
rates among
women with
lower-risk
pregnancies
varied by a
factor of 15
TOTAL KNEE REPLACEMENT
In a 2012 study, researchers provided
patients in a Washington state health system
with "decision aids," which included
information on joint replacements and
alternative treatments.
link to more information
2.4%-
36.5%
link to source
38% 70%
26%
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Wrong diagnosis, unnecessary procedures, and overtreatment are recognized but persistent problems. Getting
high quality independent opinion from a panel of precisely selected top experts is the solution.
Click book cover for more information
When top doctor is away
from hospital, FEWER
patients die…
How unnecessary
device implantations
hurt patients for life