November 18, 2015

Are Seniors to Blame?

A recent Globe and Mail article’s startling headline “Canada’s health-care system braces for hike in costs with influx of seniors” appears to point the finger at the aging boomer demographic, stating that because the senior demographic is growing exponentially in Canada, this will cost Canadian taxpayers and governments more in health care dollars.

It’s inevitable that as we age we require more medical care. And the more health care needed, the greater the expense. However this information begs to question – what exactly makes up the hike in costs? After doing a little research, it became clearer to me that the issue isn’t necessarily the demographic, but rather how government coffers are spent.

The infographic below (courtesy of CIHI - the full report can be found here) shows that the largest health expenditures are for Hospitals, Physicians and Drugs. And it’s no surprise that when seniors’ health begins to decline, this is typically where the costs end up.

Where are Canada's health care dollars going?

Picture this: a boomer has heart palpitations, goes to his family doctor (PHYSICIANS), is referred to a cardiologist (PHYSICIANS) who diagnoses him with heart disease and prescribes medications (DRUGS). As the months and years go by, the medications cease to assist and the patient is hospitalized after a triple-bypass surgery (HOSPITALS). Unfortunately this is an all-too common scenario.

But what would happen if the boomer were regularly seeing a personal trainer and nutritionist? Maybe the palpitations wouldn’t appear in the first place. Or if the patient had received an alternate opinion on the treatment prescribed by the cardiologist? Maybe the medication would have been sustainable.

What would happen if we invested more in alternative or preventative health care? Maybe seniors who don’t require acute care can go to a long-term care or rehab facility, instead of occupying very expensive hospital beds. Maybe instead of going through costly procedures, Canadians can get a second opinion and learn that there are more economical (yet equally successful) alternatives for treatment.

Maybe, just maybe, it’s not on whom we’re spending our health care dollars, but rather how we are spending them.

A recent Globe and Mail article’s startling headline “Canada’s health-care system braces for hike in costs with influx of seniors” appears to point the finger at the aging boomer demographic, stating that because the senior demographic is growing exponentially in Canada, this will cost Canadian taxpayers and governments more in health care dollars.

It’s inevitable that as we age we require more medical care. And the more health care needed, the greater the expense. However this information begs to question – what exactly makes up the hike in costs? After doing a little research, it became clearer to me that the issue isn’t necessarily the demographic, but rather how government coffers are spent.

The infographic below (courtesy of CIHI - the full report can be found here) shows that the largest health expenditures are for Hospitals, Physicians and Drugs. And it’s no surprise that when seniors’ health begins to decline, this is typically where the costs end up.

Where are Canada's health care dollars going?

Picture this: a boomer has heart palpitations, goes to his family doctor (PHYSICIANS), is referred to a cardiologist (PHYSICIANS) who diagnoses him with heart disease and prescribes medications (DRUGS). As the months and years go by, the medications cease to assist and the patient is hospitalized after a triple-bypass surgery (HOSPITALS). Unfortunately this is an all-too common scenario.

But what would happen if the boomer were regularly seeing a personal trainer and nutritionist? Maybe the palpitations wouldn’t appear in the first place. Or if the patient had received an alternate opinion on the treatment prescribed by the cardiologist? Maybe the medication would have been sustainable.

What would happen if we invested more in alternative or preventative health care? Maybe seniors who don’t require acute care can go to a long-term care or rehab facility, instead of occupying very expensive hospital beds. Maybe instead of going through costly procedures, Canadians can get a second opinion and learn that there are more economical (yet equally successful) alternatives for treatment.

Maybe, just maybe, it’s not on whom we’re spending our health care dollars, but rather how we are spending them.

March 17, 2015

Beware the Quickie Second Opinion

Because I monitor the marketplace of medical advisory services, I see trends come and go. One that’s currently in vogue is the “quickie” second opinion – a virtual case review that’s completed in about 2 – 3 days. After taking a closer look at the quickie second opinion, I think I have a better understanding of how it works, and so I have just one question –

Why in the world would you want one?

At Best Doctors, the problem we hear about all the time is that physicians don’t have enough time to spend seeing their patients and reviewing their cases, which invariably leads to missed diagnoses and incorrect treatment plans.

stopwatchI get it – we all want things quicker, but with second medical opinions, speed comes at the expense of getting it right. So let’s look at the anatomy of both kinds when a member needs help—

With a quickie second opinion, the member submits an online form that asks questions like, What’s your existing condition?, Describe the problem you’re having, or What type of doctor do you want to review your case? Here’s the trick – when facing medical uncertainty, the most common answer to those questions is “I have no idea.” With the right second opinion, a phone call is scheduled at the member’s convenience and a clinician takes whatever time is needed to go through the member’s medical history and questions.

With a quickie second opinion, members submit their own medical records online, or records are collected on their behalf from a single office. The problem? Members don’t often have their complete records (I certainly don’t have glass pathology slides lying around the house) and they typically have seen different doctors in different facilities. With the right second opinion, members grant permission and a records professional collects all relevant records and test samples from wherever they might be.

With a quickie second opinion, once (partial) records are in, the case goes to a specialist who has a particular affiliation or has an arrangement to do a certain number of cases. With the right kind of second opinion, the case goes to a specialist who has been peer nominated for clinical skill and independently verified, and that doctor gives the case a full and complete review.

With a quick second opinion, once the case review is done, findings are immediately sent to the member to ‘stop the clock’. With the right second opinion, a detailed report is written, which is reviewed for quality by a staff physician, and recommendations are put into plain English. Furthermore, rather than digitally dumping it on the member, a conversation takes place between the member and clinician, so that all questions are answered and the necessary time is spent.

It’s true – there are absolutely some cases (acute injuries, surgeries already scheduled, etc.) that demand a speedy turnaround, and there are mechanisms to do that. But what most cases demand is the clinical rigor that only comes from a detailed, deliberate case review.

I don’t blame other companies for trying to be like Best Doctors, but when you take a closer look at the services, it’s far from an apples-to-apples comparison. More like apples to aircraft carriers. In the world of virtual second opinions, it’s quickie or quality, and when it comes to your health, who has time for shortcuts?

Because I monitor the marketplace of medical advisory services, I see trends come and go. One that’s currently in vogue is the “quickie” second opinion – a virtual case review that’s completed in about 2 – 3 days. After taking a closer look at the quickie second opinion, I think I have a better understanding of how it works, and so I have just one question –

Why in the world would you want one?

At Best Doctors, the problem we hear about all the time is that physicians don’t have enough time to spend seeing their patients and reviewing their cases, which invariably leads to missed diagnoses and incorrect treatment plans.

stopwatchI get it – we all want things quicker, but with second medical opinions, speed comes at the expense of getting it right. So let’s look at the anatomy of both kinds when a member needs help—

With a quickie second opinion, the member submits an online form that asks questions like, What’s your existing condition?, Describe the problem you’re having, or What type of doctor do you want to review your case? Here’s the trick – when facing medical uncertainty, the most common answer to those questions is “I have no idea.” With the right second opinion, a phone call is scheduled at the member’s convenience and a clinician takes whatever time is needed to go through the member’s medical history and questions.

With a quickie second opinion, members submit their own medical records online, or records are collected on their behalf from a single office. The problem? Members don’t often have their complete records (I certainly don’t have glass pathology slides lying around the house) and they typically have seen different doctors in different facilities. With the right second opinion, members grant permission and a records professional collects all relevant records and test samples from wherever they might be.

With a quickie second opinion, once (partial) records are in, the case goes to a specialist who has a particular affiliation or has an arrangement to do a certain number of cases. With the right kind of second opinion, the case goes to a specialist who has been peer nominated for clinical skill and independently verified, and that doctor gives the case a full and complete review.

With a quick second opinion, once the case review is done, findings are immediately sent to the member to ‘stop the clock’. With the right second opinion, a detailed report is written, which is reviewed for quality by a staff physician, and recommendations are put into plain English. Furthermore, rather than digitally dumping it on the member, a conversation takes place between the member and clinician, so that all questions are answered and the necessary time is spent.

It’s true – there are absolutely some cases (acute injuries, surgeries already scheduled, etc.) that demand a speedy turnaround, and there are mechanisms to do that. But what most cases demand is the clinical rigor that only comes from a detailed, deliberate case review.

I don’t blame other companies for trying to be like Best Doctors, but when you take a closer look at the services, it’s far from an apples-to-apples comparison. More like apples to aircraft carriers. In the world of virtual second opinions, it’s quickie or quality, and when it comes to your health, who has time for shortcuts?

July 31, 2014

One Member’s Story: Simon

Every once in a while I like to use this space to share a story from one of our remarkable members. Today’s story is about Simon – a member in Canada who had an accident on the job and noticed a small lump on his finger, which turned out to be much more serious than first thought.

In some cases, our members need help in one particular area. But in Simon’s case, before contacting Best Doctors, he faced a few separate medical challenges:

  • A diagnosis that needed correcting
  • A long wait for surgery and then little follow-up
  • Pathology results that were incorrect

A timely intervention revealed that the lump thought to be a cyst was actually a form of cancer, and that further surgery was needed to address the issue. The video of Simon’s story also features thoughts from the Member Advocate who followed Simon every step of the way. As she notes, Simon wasn’t getting the answers he needed because the dots simply weren’t being connected on his case, and that’s when he contacted Best Doctors.

Thankfully, this story has a happy ending, and this member can recount his experience with a smile. Simon puts his case in perspective, noting that because of the intervention he experienced moderate loss of feeling in one finger, which is remarkable given what could have been a very different outcome. For Simon, a life threatening illness gave way to a “life changing wake-up call.”

Every once in a while I like to use this space to share a story from one of our remarkable members. Today’s story is about Simon – a member in Canada who had an accident on the job and noticed a small lump on his finger, which turned out to be much more serious than first thought.

In some cases, our members need help in one particular area. But in Simon’s case, before contacting Best Doctors, he faced a few separate medical challenges:

  • A diagnosis that needed correcting
  • A long wait for surgery and then little follow-up
  • Pathology results that were incorrect

A timely intervention revealed that the lump thought to be a cyst was actually a form of cancer, and that further surgery was needed to address the issue. The video of Simon’s story also features thoughts from the Member Advocate who followed Simon every step of the way. As she notes, Simon wasn’t getting the answers he needed because the dots simply weren’t being connected on his case, and that’s when he contacted Best Doctors.

Thankfully, this story has a happy ending, and this member can recount his experience with a smile. Simon puts his case in perspective, noting that because of the intervention he experienced moderate loss of feeling in one finger, which is remarkable given what could have been a very different outcome. For Simon, a life threatening illness gave way to a “life changing wake-up call.”

July 16, 2014

INFOGRAPHIC: The Numbers on Expert Second Opinions

Best Doctors has just released a new infographic that brings into focus some of the numbers around expert medical second opinions. Some key points I’d like to highlight—

More than a third of cases see some type of change made to the diagnosis, and well above two-thirds of cases have some shift in treatment. The changes could be modest or they could be massive, but behind them all is the peace of mind in knowing that the diagnosis or treatment is the right one.

Also, we track the reasons why people seek a second opinion in the first place, and most interesting to me are the two least common reasons: patients having no diagnosis and being skeptical of their doctors. For most people, it’s not that they mistrust their specialists or haven’t been able to get a diagnosis – it’s just that they want to be absolutely sure.

Finally, pathology reviews by experts. Most second opinion services are not equipped to re-review pathology samples, but Best Doctors is, and it happens for 1 in 5 cases. Of the cases with a pathology review, 1 in 4 produces a different result. That’s 5% of all cases, but 25% of cases with pathology samples, and a different result could be as significant as a change in cancer diagnosis, so it’s hard to overstate the importance of getting it right.

What numbers and findings stand out to you?

second opinions

Best Doctors has just released a new infographic that brings into focus some of the numbers around expert medical second opinions. Some key points I’d like to highlight—

More than a third of cases see some type of change made to the diagnosis, and well above two-thirds of cases have some shift in treatment. The changes could be modest or they could be massive, but behind them all is the peace of mind in knowing that the diagnosis or treatment is the right one.

Also, we track the reasons why people seek a second opinion in the first place, and most interesting to me are the two least common reasons: patients having no diagnosis and being skeptical of their doctors. For most people, it’s not that they mistrust their specialists or haven’t been able to get a diagnosis – it’s just that they want to be absolutely sure.

Finally, pathology reviews by experts. Most second opinion services are not equipped to re-review pathology samples, but Best Doctors is, and it happens for 1 in 5 cases. Of the cases with a pathology review, 1 in 4 produces a different result. That’s 5% of all cases, but 25% of cases with pathology samples, and a different result could be as significant as a change in cancer diagnosis, so it’s hard to overstate the importance of getting it right.

What numbers and findings stand out to you?

second opinions