General Information to Second opinions
Following medical documents / reports are necessary for doctors / professors to prepare a Second Opinion:
An actual medical report of the treating doctor at home with
- A short and relevant disease history,
- The actual status of the patient including symptoms like pain and already diagnosed diseases
- Any relevant side diagnosis (example: if you are a heavy smoker and you have heart problems, the side diagnosis 'smoking abuse' is very relevant; if you had a broken leg when you were a child and you plan to come because of a prostate cancer the broken leg years ago is not relevant) – diabetes, obesity, smoking, heart problems – are mostly sever side diagnosis
- Any family history (some diseases show predispositions or even gene predispositions; some types of cancer might have family aspects like breast cancer or rectum cancer)
- An actual blood screening
- Picturing documents (e.g. x-ray, CT, MR, endoscopic videos, heart-echo video) – pls. be aware of the fact that all picturing documents can be sent by email nowadays!!!
- Histology report – this is a cell-analysis report; doctors at home must have been resected or done a biopsy to take out some suspected cells to analyse (mostly if there is a suspect of a tumour – PLS. BE AWARE OF THE FACT: a tumour is just a space getting / eating cell collection and it can be good (benign) or bad (malign)
- Sometimes, photos are necessary, especially after severe burns or any operations with a beauty surgery affect
A second opinion is stating (Content):
- Possibly further necessary diagnostic steps that need to be done
- General therapy alternatives for the disease
- A concrete therapy proposal out of the therapy alternatives with explanation why the specialist is recommending this one therapy - as statement of a proven medical specialist (always a medical doctor!) who is specialized on the disease
- Short explanation of the research/science status
- Further medical information (on medication, on living rules, on alternative)
GHMC can deliver further supportive medical information
Further supportive-medical measure like:
- diet plans
- Homeopathic measures
- Physiotherapy or psychotherapy
- Measures of chiropractic
- Sportive measures
GHMC offers further administrative information like:
- Price-/cost estimation of the proposed medical treatment
- Possible financing options
- Contacting caring companies who organize nurses visits in the hotel
- Consulting in private nurses for at home (for Germans: homes for older people or for people who need care regularly; alternative living and care projects)
There are Second Opinions for all medical indications!
Most requests from patients (internationally and from Germany) are in following medical areas (in brackets: examples):
- Cancer diseases
(locally like stomach cancer or systemic like leukaemia = blood cancer)
- Diseases of the muscle- and skeletal system, especially joints
(either diseases of older people like joint arthrosis, mostly knee, hips, or hereditary diseases – patients are born with a mal- or dysfunction like for instance a wrong position of the hip
- Back bones diseases, all types
(in Germany, people's disease No 1: back pain)
- Heart- and blood circle / vascular diseases
- Diabetes (often combined with obesity)
- Urological diseases
- Liver diseases
- Immune- and auto-immune system diseases
(Rheumatic, Systemic lupus erythematodes)
- Neurology diseases
(Parkinson, Alzheimer, Multiples Sclerosis)
- Children's diseases
Cancer treatments – general treatment options
- local: operation - surgical option (resection of a tumour)
- systemic: chemotherapy
- local/systemic: radio-oncology
- systemic: hormone therapy
- conservative therapy (physiotherapy, pain management, 'wait-and-see-approach')
- local: special chemotherapy positioning inside the body close to a tumour
- local bringing radioactive seeds/material inside a body; local systemic
Depending on each individual medical case / situation single treatment option or combinations of those treatment option are possible. For each cancer situation there are defined treatment options. Example: prostate cancer: fully metastasized (often in bones): hormone therapy; not metastasized (majority, about 90 %): either operation (surgical option) or radiotherapy or radioactive seeds implant. On the one side, an operation is very successful and it takes about 10 days in the hospital but some patients are afraid of the operation so they choose radiotherapy which takes about 6 weeks with so called fractionized radiation, before radiation planning with CT, and then with a time schedule radiation fractions. For both treatment options results are very good so that about 95 % of patients with prostate cancer can be healed. Main rule is: do not come too late.
You see, there is a difficult decision-making process where patients need professional consultancy – and maybe not necessarily a specialist. For prostate cancer, urologists, who do the operation, will always go for an operation if general quality criteria allow it (operation or radiotherapy only possible if prostate cancer is not metastasized) and radio-oncologists will always recommend radiotherapy…. Of course, those specialists introduce all treatment options generally but they are –naturally- more convinced of their medical specialization.
Quality of a therapy proposals and therapies is influenced by:
- Are there reliable medical documents?
- Is the specialist experienced enough to call himself a specialist? Golden rule: quantity is quality – the more patients with certain diseases the specialist has treated the more experienced the specialist is. The more operations the specialist has done the more experienced and the higher the medical quality. The other way around: if a doctor is doing a difficult operation only 3x a year he cannot call himself a 'specialist' because he cannot be experienced enough with to few operations.
- Is the specialist / doctor also doing research work or is he doing clinical trials or is he using new (but formally confirmed) treatment methods?
- Is a specialist team-working with other specialists on an interdisciplinary basis? In bigger German hospitals there are interdisciplinary teams regularly meeting and discussing actual cases. In many hospitals there are so-called 'tumour-boards', twice a week, where surgeons, oncologists, radio-oncologists, radiologists, pathologists are discussing best treatment options for each individual case/patient.
- For very severe and complex diseases: is the hospital having more medical infra-structure like intensive-care-units (ICU), physiotherapists, psychologists and so on.
- Especially for international patients: is the hospital having infrastructure for international patients like: special responsible staff (like in the International Office), medical translators, administrative & medical staff that speak different languages, is there an open minded service mentality for foreigners, are responsible persons/hospital staff having experiences with international offices.
General rules for patient's movements to hospitals in Germany:
- the more complex a disease and a treatment is, the bigger a hospital should be
- the easier and less complex and elective (means possible to time-schedule, no emergency) the more specialized a hospital should be
- the more side diagnoses (multi-morbid situation) the more complex a disease situation is and thus the hospital should be bigger
Example – hip replacement:
- For a normal hip replacement without significant side diseases a patient can go / should go to a specialized centre, in Hamburg Tabea-Hospital; they do those operations daily many times; here it does not make sense to go to a huge University hospital
- for a hip replacement with an already infected joint situation, side diagnoses as diabetes, patient had already heart attacks, had a cancer disease already and so on, it might make sense to go to a bigger, generalized hospital (University hospital)
- a knee joint problem: patients go to specialists in specialized small centres. Knee treatment is almost only a specialized small centre treatment and not an issue for bigger hospitals like university hospitals. Example: Tabea-Hospital Hamburg is the luxury hospital in Hamburg in the most famous luxury part of Hamburg in Blankenese, where many German celebrities live. The knee specialist of the Tabea-Hospital is highly specialized on joints; he is the personal doctor of the Klitschko-Brothers and other famous German or Germany-based celebrities. So it does not make sense to go to a huge hospital where those specialists do not exist (they are otherwise qualified) and where the individual luxury treatment and service is not possible!
Difficult medical cases
Following medical constellations are defined as difficult and should be considered to need support far above average of all involved German institutions:
- multi-morbid patients
- already treated patients (in home countries). To start treatment in the home country is normal and understandable. But sometimes it is better to come immediately to Germany because of medical quality and financial aspects. Chances for healing might be much higher in Germany!
- Many international patients often come much too late!!! THE EARLIER A DISEASE IS TREATED THE HIGHER CURING/HEALING CHANCES ARE!!!
- So-called infaust (diagnose with a quiet sure prognosis to die) or pre-final disease situations: there are patients who are so seriously ill, already treated but not successful or came much too late – so there is no treatment option (world-wide) for those patients.
Treatment options are mainly curative (healing) or palliative (not healing, keeping up life quality):
curative – means, the medical treatment has as goal a complete healing for the patient; curative treatment approach defines the type of medical treatment;
palliative – means, the disease situation does not allow anymore a curative approach. A palliative treatment can last a couple of weeks up to many years depending on the individual disease/patient's situation. Normally, palliative treatment is aiming towards a pain-free, respectable, self-defined life quality, trying to avoid extreme medical situations – And again: support of a patient by all means, mainly based on respect to everything what makes the life of the patient better and what helps the patient.
There are different supportive treatment options that support curative and palliative treatment options, quite often especially palliative situations are looking for supportive possibilities like further palliative chemotherapy of the school medicine approach but also alternative medicine approaches like Traditional Chinese Medicine (TCM) or Ayurveda-Medicine or special nutrition approaches.
ATTENTION: if patients are in a special situation that school medicine, even in Germany, cannot offer any treatment options except of a palliative, short-term solution that helps the patient to have a honourable last time period of his life – they search desperately for help and there are not serious offers by criminal companies or single persons who promise curative help.
Most of the offers for patients in a palliative or even not treatable medical situation are good and not criminal, also done by good specialists. But there are, unfortunately, also persons or small private companies that misuse the situation of those patients and offer treatment options that mainly cost a lot but not more.
Pls. always check realistically the medical situation of the patient and look at a reasonable relation between offered services and prices.
Pls. check who is making those offers, pls. check, whether the treatment options persons and companies are offering are official, confirmed and standardized treatment options. Normally, private or state hospitals do not offer not confirmed, not standardized treatment options!!!!
There are many severe children’s diseases that have a good chance to get identified and treated. In Germany, babies and children do have a good chance because from the very beginning babies and children are monitored and treated by excellent doctors in an excellent healthcare system.
In many other countries in the world, there is the treatment of systemic and complex disease not possible or at least very limited. Children might be born with diseases, difficult to identify and diagnose, and even more difficult to treat. In Germany, children have a much higher chance to survive and to get best medical quality of treatment. Many countries worldwide, each single country is one too many, cannot offer this quality treatment to their children as Germany can do. And even if children’s diseases are not curative but the quality of life is extremely different.
The problem is that in Germany, even the medical treatment of children must be paid, somehow, as any other medical treatment in Germany. Quite often, parents from other countries with sick babies / children try to get as much money as possible to let their kid treated in Germany. Then German doctors/specialists have to weigh up carefully whether there is a realistic chance for treatment with a curative or at least a realistic palliative approach. It does not make sense when parents from Sudan sell their whole belongings in order to come to Germany and let the only son amongst many daughters introduced to doctors and then get the answer that there is no treatment option for the kid. For example, there are a couple of systemic children’s disease severe spastic contractions that do not allow the kid to learn normal walking, moving, sitting down. In Germany, those kids might have a chance to get medical treatment options with surgical, systemic and conservative (physiotherapy) approaches so that those kids can overcome the problems and finally have a self-defined life even later when they are grown up without support from outside.
Extremely difficult are situations where children are in coma or paralysed or brain damaged situations with terrible consequences on the whole body and with no treatment option at all, except of an intensive-care long-term treatment in an highly technical-medical environment without having any chance for healing. Even in Germany, those little patients cannot get good treatment options. At least those children might get beloved care and relief. Maybe. The more devastating it is for parents with kids who might be in such a situation and where healthcare system of their country is simply not at an acceptable level and where parents left alone with this almost not manageable problem, not realistically and not emotionally.
GHMC is offering to look for possible financing alternatives for single individual cases, e.g. via non-profit-organisations worldwide.
Unfortunately, we have to emphasize that only a few cases might get offered alternatives, medically and financially, because the world is not doing everything for their children! Which is not acceptable but which is the realistic situation.