Second opinion portal Doctors warn against remote diagnosis

Specialists criticize second opinion by online remote diagnosis and suspect financial interests

22.08.2011

In Germany too many operations are carried out. This position represents twelve experienced and renowned surgeons and founded the „Advisory portal against unnecessary operations“. The portal is not undisputed: A part of the medical profession criticizes the project as „highly dubious“ and profit oriented. Without a personal idea no comprehensive diagnosis can be made, so the criticism.

Caution operations: Online portal for medical second opinion
The second opinion portal is designed to help all patients make a final decision. „Is a medical intervention useful or not“. Twelve physicians of various disciplines have joined forces to provide patients with decision-making assistance through a medical portal against unnecessary surgery. For in her view, especially in Germany too hasty operations on the back, the hip or knee are performed. „In many cases even the suffering is aggravated“. One of the founders of the patient portal „Careful operations“ is Prof. dr. med. Hans Pässler from Heidelberg. Pässler complains to the „dpa“: „Germany is not only a leader in the automotive industry, but also in operating“. According to the university teacher and knee expert countless interventions are performed not for the benefit of the patient, but the doctor. To underline his arguments Pässler compares Germany with other European countries. In terms of the total number of inhabitants, for example, twice as many operations are carried out in Germany than in Sweden. The obvious reason: In Sweden, the doctors get a fixed salary. Especially in outpatient procedures, the numbers in Germany have been rising for years. A resident surgeon works with surgical centers where operating rooms are rented. To make up for the cost of the rent, the doctor has to perform many operations.

For more than half of the interested parties who have so far used the second-opinion portal, an operation would have been unnecessary from the perspective of the medical profession. In order for telediagnostics to take place at all, patients must scan medical reports, laboratory findings and X-rays and send them online. In addition, patients must complete a detailed questionnaire. Currently, 12 experienced and longer-term specialists are involved. In total, 16 specialists will be involved in the future. But a credit balance is not in vain. Whether someone is privately or legally insured, a medical second opinion costs between 200, 400 and 600 euros, depending on the scope of the diagnostic tasks. The rush seems to be great. According to the portal „www.vorsicht-operation.de“ 150 patients have already registered in the first weeks after opening.

Sharp criticism from specialists and associations
Many colleagues find the new portal no approval. When „highly dubious“ The Professional Association of Registered Surgeons diagnoses a remote diagnosis that does not reveal the patient. The Professional Association of German Surgeons e.V., „Diagnostic results alone are not enough to make an informed decision for the benefit of the patient“. Rather, physicians need to look at the patient and their social environment as a whole. Especially the latter point is of great importance when it comes to a major medical intervention. „Because we operate humans and not X-rays“, said Professor med. Hans-Peter Bruch, President of the Association. Harsh criticism expressed by the association chairman on the paid model. Because one „well-founded, free second opinion is already practiced today in German surgery“. Patients would therefore have to spend no extra money to get a second opinion. For the statutory health insurance allow it to obtain a second opinion from a second doctor. The association offers help to all patients if they are unsure.

The Professional Association of Orthopedic Surgeons and Traumatology is also that the portal is not a suitable address to receive a detailed second opinion. So said the vice president of the association, dr. med. Andreas lanes: „Sometimes there are terrible pictures - and the patient is still playing golf“. It could be that the doctors are concerned about the profit. For as an orthopedic surgeon, he himself can only charge 21 euros for a consultation including an examination. The flat rate is even lower for the statutory health insurance. The second opinion portal defends itself against such arguments. The calculated fee is justified, since the competent physician deals with a case for at least two hours. By the detailed questionnaires the doctor could more per „Remote diagnosis learned“, as at one „Two-minute call“ in practice, says Pässler.

Health insurance companies express interest in reimbursement
Some health insurance companies have already expressed interest. For example, the private Debeka is likely to take over the costs during a set test time and then continue to decide how a speaker told the cashier. In the statutory health insurance, the Association of German health insurance funds (BKK), a cooperation. Other funds, however, refer to their own second opinion offers. For example, the Techniker health insurance company in a back center to a second opinion. After initial results could be determined here, that nearly 85 percent of the operations are superfluous.

Little money for alternative treatments
Instead of medical interventions, a variety of conservative therapies such as physiotherapy and physiotherapy or alternative concepts such as osteopathy or chiropractic are available. The former lack sufficient budgets and in the latter only the private funds take over the costs. But even the second opinion portal could not make an adequate offer, if the diagnosis means that an intervention is superfluous. The patients are then back at the beginning. (Sb)

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Picture: Rainer Sturm