Centre for Medical Expertise
Independent expertise for complex medical cases
Second opinion · Third opinion · Integrated medical file analysis
When a medical file becomes complex
Over recent decades, medicine has undergone a remarkable evolution. Thanks to highly specialised diagnostics, innovative treatments and continuous scientific progress, physicians today have possibilities that were unthinkable only a few years ago.
At the same time, healthcare has become increasingly complex. Patients with a complicated clinical picture are often followed by several specialists, each working from their own field of expertise. This is one of the great strengths of modern medicine, but it can make it harder to bring the full medical story back together as a single coherent whole.
It is precisely in such situations that an independent and integrated assessment of the complete medical file can offer added value.
After more than thirty years of clinical experience, I have deliberately developed my practice towards an environment in which time, independence, scientific grounding and integrated clinical thinking are central.
My task is to analyse complex medical files as a whole once more, to critically assess the available medical information, and to support the patient — and where appropriate their treating physicians — with an independent medical opinion.
Who is it for?
An extensive analysis of a medical file may be appropriate in cases involving:
- an unclear diagnosis despite extensive investigation;
- several conditions that influence one another;
- an extensive file involving a number of different specialists;
- conflicting test results or medical opinions;
- insufficient results from previous treatments;
- rare or complex conditions;
- important diagnostic or therapeutic decisions;
- the need for an independent second or third opinion.
General practitioners and medical specialists may also refer a patient for an independent assessment.
Whether a file is suitable for this form of expertise is assessed individually.
Detailed analysis before the consultation
An important part of the medical expertise takes place before the consultation itself.
The available medical file is gathered as completely as possible and studied again. Depending on the question at hand, the following may be assessed:
- the medical history and the chronological course of the illness;
- laboratory investigations;
- specialist reports;
- medical imaging and the accompanying reports;
- anatomopathological examinations;
- genetic analyses;
- current and previous medication;
- previous and ongoing treatments;
- relevant lifestyle and risk factors.
These various elements are not considered in isolation, but assessed as far as possible in their mutual coherence.
Where relevant, and with the patient’s consent, consultation may take place with the treating general practitioner, radiologist, specialist or another qualified care provider.
The consultation
Three hours are generally set aside for the consultation, in order to discuss the medical file, the course of the illness and the main questions in detail.
Among the points examined:
- what is medically sufficiently clear;
- where uncertainties or contradictions remain;
- which findings deserve particular attention;
- whether further investigation could be useful;
- which diagnostic or therapeutic options can be discussed further;
- and which questions may need to be raised with the treating physicians or specialists involved.
A written, reasoned medical opinion may follow from this.
More than the medical file alone
For me, an integrated assessment does not stop at diagnosis, medication and technical investigations.
Where medically relevant, attention is also given to lifestyle and preventive medicine, including:
- nutrition;
- physical activity and muscle health;
- sleep and recovery;
- stress and mental resilience;
- metabolic and cardiovascular risk factors;
- body composition and functional health;
- other modifiable lifestyle factors.
In addition, it can be examined whether, alongside regular treatment, there are scientifically substantiated complementary options that could form a meaningful and safe addition in the individual situation.
This takes into account the available scientific evidence, its strengths and limitations, possible contraindications and interactions with existing treatment.
Complementary interventions are explicitly assessed as an addition to, and not a replacement for, regular medical treatment.
Scientific approach
Every expertise is carried out as far as possible according to the principles of evidence-based medicine.
Current scientific literature, relevant medical guidelines, the available clinical data and clinical experience are brought together in order to reach the most carefully considered individual advice possible.
Where modern digital analysis methods are used, they serve a purely supporting function. The final medical judgement always remains based on a personal and independent clinical assessment.
Independent and complementary
This medical expertise does not replace the treating general practitioner or specialist.
It has an independent and advisory character and is intended as a complement to existing medical care.
The assessment carries no guarantee of finding a new diagnosis or treatment.
Diagnostic and therapeutic decisions and further medical follow-up continue to take place within the regular doctor-patient relationship and, where appropriate, in consultation with the specialists involved.
Open collaboration and mutual professional respect are an essential starting point in this.
Fee
A thorough assessment of a complex medical file generally requires considerably more preparation time than a conventional consultation.
Base fee: € 600
This includes:
- the initial thorough analysis of the available medical file;
- the preparation of the expertise;
- the extensive personal consultation;
- and, where appropriate, a written medical opinion.
The base fee is settled before the substantive analysis of the file begins. Payment details are provided once the appointment has been confirmed.
For exceptionally extensive or complex files, additional time may be necessary, for instance to analyse very substantial documentation, to carry out targeted scientific literature research, or to consult other qualified care providers. Where it can reasonably be estimated in advance that an additional fee will be necessary, this is discussed with the patient beforehand.
Costs for additional laboratory investigations, medical imaging, technical examinations or services provided by external physicians, laboratories, hospitals or other care providers are not included in the base fee.
Practical information
Ahead of the consultation, the patient is asked to make the necessary identification details and relevant medical information available.
For electronic consultation of health data, only access that meets the applicable legal conditions and of which the patient is aware is used.
Medical documents that are not available electronically can be provided in advance through a suitable secure channel.
Once the necessary data is available and the base fee has been received, the substantive analysis of the file can begin.
This allows thorough preparatory work to take place before the consultation, so that during the personal meeting maximum time can be devoted to analysis, interpretation, integrated advice and discussion of possible next steps.
Vision
I am convinced that further medical specialisation remains essential, but that there is also a need for physicians able to free up enough time to bring the full medical story back together and see it as a whole.
When a file becomes exceptionally complex, an independent assessment in which all available information is critically analysed again in its coherence can contribute to greater clarity and better substantiated medical decision-making.
That is the essence of this medical activity and the reason for the existence of the Centre for Medical Expertise.