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Do I really need this procedure? The power of a second opinion

Going under the surgeon’s knife isn’t a decision that’s taken lightly, either by a patient or by the doctors treating them.

Operations are a last resort; they’re invasive with potentially serious medical risks, and patients need to be sure they’re essential before deciding to go ahead. And if they do make that decision, patients want to know:

a)               Do I really need this procedure?

b)               If I do, how do I know the best people will be taking care of me?

If you live or work abroad, opting for surgery is an especially difficult decision, with patients often struggling to deal with language, cultural and medical expertise issues in an unfamiliar health care system.

“Our in-country teams make sure patients are getting the correct care for them”

Getting the correct treatment

Private medical insurers like Aetna International, provide reassurance for members who need treatment while they’re living outside their home country. By working with the member’s attending doctor, our Care and Response Excellence (CARE) team makes sure patients get the most appropriate care, calling on an international panel of expert consultants for second opinions on treatment.

In cases where the local resources or health care system are not able to provide the right care, they can arrange medical evacuations to recognised specialists, anywhere in the world.

The CARE team

Getting a second opinion

If an Aetna International member needs help, their treating physician will send referrals and requests for treatment through to the CARE team. Under the guidance Medical Director, Dr Mitesh Patel, the team reviews the case, discusses it with the member’s doctor and together they make a decision on the best course of action for the patient. This collaborative process makes sure the treatment is in the member’s best interests and will ensure the best health outcome.

“We always make sure our members receive only the most medically appropriate surgery,” explains Dr Patel. “Otherwise, the patients are at risk of complications and possible further surgery.”

“The team’s experience and global reach means they can suggest second opinions that offer more effective treatment”

 

Often the CARE team will concur with the member’s treating doctor or surgeon and are happy with the quality of the available health care, in which case surgery is approved and scheduled. But the team’s experience and global reach means that, more often than not, they can provide an alternative treatment path that offers a more effective solution than the proposed surgery.

International expertise

“We have access to an independent panel of specialists,” says Dr Patel. “World-class authorities on everything from neuro-surgery to paediatrics. We ask them to review specific cases and, if necessary, we’ll fly people to get treatment directly from them, no matter where they live in the world.”

For globally mobile members, the CARE team brings an invaluable layer of expertise to their treatment, helping to support their treating doctor and ensuring the best health care outcome.

Second opinions: a case study

In some cases, there may be a more suitable option for the patient and the CARE team has ethical and moral duties to offer alternatives. Dr Patel recalls a referral from a patient in Dubai who’d been suffering from neck pain for three months.

“Had we authorised that surgery, the bone would have crumbled like cheese” 

An MRI scan had revealed disc compression on the spinal cord of one patient, caused by osteoporosis. The patient’s consultant contacted Aetna International to request preauthorisation for highly complex and risky surgery that involved wrapping a titanium cage around the spinal cord. Preauthorisation is a chance to check the patient is eligible for treatment, and for the CARE team to review whether the treatment is medically necessary. The team’s decisions are based on ensuring the patient has the best health outcome and they may suggest alternative options, which can also be more cost effective, helping to keep member premiums in check.

For Dr Patel and his team, the proposed surgery in this case wasn’t the right approach.

“Had we authorised that surgery, the bone would have crumbled like cheese,” he explains. “It would have resulted in the member needing further surgeries and, possibly, paralysis.”

Drawing on medical expertise from colleagues around the world, an alternative suggestion was put forward. Treatment that involved a medical evacuation to a specialist in the UK, and simpler surgery that delivered better long-term results.

Alternative care

Second opinions aren’t always about deciding between two operations. The CARE team considers all the available treatments and in many cases surgery isn’t the best option for the patient.

In another referral handled by Dr Patel, the parents of an 18-month-old baby in Dubai called for advice regarding their son’s knock-knees. Their consultant had suggested surgery would fix the problem, but the parents had reservations about a treatment plan that involved annual operations for the next five years.

“Almost all cases resolve naturally as the child grows older”

For Dr Patel and his team, invasive surgery in this case wasn’t necessary. “It’s normal for children to have knock-knees between the ages of two and five years of age,” he explains. “Almost all cases resolve naturally as the child grows older.”

Avoid unnecessary surgery

The CARE team works hard to make sure the patient’s best interests are kept at the heart of the decision-making. If a surgery, or invasive treatment is essential, it’s an easy call to make. But if it can be avoided, if there are better treatments or alternative options, avoiding an operation is always preferred. Dr Patel agrees, "In both these cases, we were directing patients out of harm's way, by protecting them from unnecessary surgery.”

The right treatment at the right time… wherever you are

For Aetna International’s CARE team, the emphasis is on ensuring members receive the right treatment at the right time, and in the right location. Many of our members live and work in countries where either the quality of the health care system, or the availability of specialists, is limited compared to their home country. Knowing the CARE team is on hand to offer trusted advice, a second opinion or, if necessary, organise an emergency evacuation to a specialist anywhere in the world is an enormous reassurance.

Employers and brokers can speak to our expert advisors to find out about the full range of services available through the CARE team and to learn more about our health insurance plans. Get the contact information for your region, here.

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