How a doctor’s second opinion is just a click away for Hongkongers - and whether that’s a good thing
Online services offering access to medical experts in Europe and the US can prevent unnecessary surgery and provide alternative treatments, their founders say, as telemedicine gains traction
What if you twisted your knee, tearing your anterior cruciate ligament, and a doctor suggests surgery costing around HK$150,000. Would you have the operation?
Perhaps you might want a second opinion. These days that’s as easy as turning on your computer. If you uploaded MRI scans to Taipan Health’s taipanhealth.com service website, you would get a another opinion within 24 hours from a doctor with a leading medical institution in Europe or the US for HK$1,289.
Maarten Kwik, who founded Taipan Health five months ago, says in Europe second opinions have prevented unnecessary treatments in about 5 per cent of cases. “There is clear evidence that second opinions improve both the financial and medical outcome for consumers,” says Kwik, a Dutchman who has lived in Hong Kong for six years.
Taipan Health focuses mainly on radiology advice and leverages a network of more than 150 Western specialists and sub-specialists selected by the company’s medical director, Dr Hans Smeets. He is a consultant radiologist and telemedicine entrepreneur who founded Teleconsult Europe, a Netherlands-based company that offers radiology services to hospitals, clinics, diagnostic centres, laboratories, medical services companies and the Dutch government.
Online medical advice has been a trend in the US for a few years. Some of these services are offered by established medical centres, such as Johns Hopkins http://www.hopkinsmedicine.org/second_opinion and Cleveland Clinic, while others are like Taipan Health – independent businesses that work with specialists on a consulting basis, such as SecondOpinions.com or BestDoctors.com.
In mainland China, such services are also taking off. The Citizen Health Platform of Shenzhen, an app run by the local government, offers second opinions from renowned American medical institutions.
Kwik says there is also a company offering over-the-phone services.
A study on telepathology in China, published in November 2015 in the Journal of Pathology Informatics by the University of Pittsburgh Medical Centre (UPMC), found that international telepathology consultations significantly altered treatment plans for more than half of the cases in which a patient’s primary diagnosis had been from referring hospitals in mainland China, usually in smaller to mid-sized cities or rural areas.
Since 2012, UPMC has provided telepathology consultation to KingMed Diagnostics, a network of 27 central laboratories serving more than 13,000 hospitals and clinics in China. Glass slides are scanned in China, and the high-resolution digital slides are then presented to subspecialty pathologists at UPMC in Pittsburgh through a customised, web-based portal.
Initially, most second opinions were requested by pathologists in China, but, over time, treating clinicians and patients reached out, the researchers noted.
Hong Kong patients don’t usually question their doctor’s diagnosis. “In Hong Kong the quality of doctors is very high, and apparently there’s been research showing that the trust level of the people in doctors in Hong Kong is very high,” Kwik says.
Sigal Atzmon, president of Medix Group, an international company with a Hong Kong regional base that offers medical case management, says: “From our experience, we have found that patients in Hong Kong can be reluctant to seek additional advice following their first medical opinion, and sometimes make quick decisions that are not always the best for them.”
Medix, headquartered in London, offers not just medical second opinions from top specialists, but an entire dedicated case management team available 24/7 to the patient, formulation of a recommended treatment plan, and support in coordinating and implementing the plan. It has 300 in-house specialists who cover all medical specialties, plus an accredited network of more than 3,000 leading specialists globally.
“Over the years we have conducted data analyses on our cases and the results are unequivocal,” Atzmon says. “On an average yearly basis, in 20 per cent of the cases we deal with, we reach a different diagnosis to the one the patient initially received. In 43 per cent of cases we recommended a different treatment plan and in 55 per cent of cases we help our patients avoid unnecessary additional consultations, treatments or procedures, including high risk invasive surgeries.”
Atzmon cited the case of a 51-year-old woman in Hong Kong who was diagnosed with an internal carotid artery aneurysm which could cause brain damage or death if it burst. The woman consulted two neurosurgeons and both advised her to have brain surgery. Three Medix specialists said surgery was not the correct action, given the high risk versus the 0.4 per cent chance of the aneurysm bursting. The specialists provided a monitoring plan and treatment advice to keep the woman’s blood pressure down and minimise the risk of bleeding. The woman is said to be doing well.
Medix’s services will cost around US$15,000 (HK$116,000) for a three-month period. The company formed a strategic partnership with insurance company AIA last year, offering AIA's top tier clients free access to Medix services.
But does a second opinion really improve patient outcomes? Studies find that the original diagnosis or treatment regimen is confirmed in most cases. For those who get a different second opinion, the result is not always a less expensive course of treatment, and there is also relatively little evidence the alternative plan gives a better outcome.
In a study published in Mayo Clinic Proceedings in May 2014 on patient-initiated second opinions, researchers compared first and second opinions and their characteristics and impact on diagnosis, treatment and patient satisfaction.
“Most patients perceive the second opinion to have value, either because it is reassuring to them that the original diagnosis or treatment plan is correct or it identifies an alternative. However, the accuracy of the second opinion through follow-up review is generally unknown, and the methodology of studying and reporting the second opinion outcomes is highly variable,” the researchers wrote.
“Given the sparse data, the practice and value of obtaining a second opinion merits more comprehensive and rigorous evaluation.”