A truly informed decision a Best Doctors case study

In 2001 when Anne (not her real name) had surgery to remove her uterine fibroid tumors, she was told by her doctor there was a high probability they would grow back. At the time, it was the last thing Anne wanted to hear – after having just experienced an extended recovery that kept her out of work for over four weeks. As many of us tend to do with an undesirable prognosis that is not imminent or life-threatening, Anne promptly put it out of her mind.

Roll forward 11 years and Anne’s doctor proved to be right – the tumors did indeed grow back. The tumors were large, ruling out less invasive laparoscopic surgery. As she was contemplating the unpleasant prospect of another surgery and a long recovery and absence from work, one of Anne’s family members encouraged her to weigh her other options to invasive surgery. Anne’s relative had sought a second opinion for the same condition and had undergone a different procedure called embolization – a minimally invasive alternative to surgery that involves preventing blood flow to an area of the body which can shrink a tumor. With a recovery time of two to three days, it seemed to be a more attractive option to Anne.

Paralyzed by analysis
However, Anne's physician discouraged the embolization procedure and informed her that the procedure was not always a permanent solution the tumors could grow back, necessitating a second surgery. Now Anne was in a quandary, knowing she should seek out other opinions, but also wanting to keep some faith in her long-term physician. Says Anne, "I got paralyzed by analysis figuring out what I should do. But, I also realized pretty quickly that every doctor I went to would tell me what to do based on their own specialty." Anne was daunted by the task of seeking out her treatment options and once again, like many of us, was beset by a full-on case of procrastination when faced with the prospect.

“I’m one of those people that knows full well I should leave no stone unturned. This is my health, this is my body, but time is not my friend and I just didn’t have the time for six different interviews with six different doctors, much less passing my x-rays around, “explains Anne. Luckily for her, Anne learned about the Best Doctors program the Business Health Care Group was exploring (of which her employer is a member)*. “My boss told me our company was considering a new program and maybe I could be involved with the pilot and be a ‘guinea pig,’ if you will.” Realizing the program could be an answer to her plight, Anne says, “I jumped all over the opportunity.”

Impressed with the process
The Best Doctors program offers patients facing difficult medical decisions access to expert medical consultations in addition to a range of other tools and resources so they may have the confidence to make informed decisions about their care. More than a traditional second opinion, Best Doctors delivers a comprehensive evaluation of a patient’s medical condition – providing value to both patients and treating physicians.

Anne accessed one of the four key program components the Best Doctors service offers called Explore My Options that includes clinical coaching and on-line decision aids for patients facing surgery to determine if less invasive treatment options are appropriate. Her first contact with Best Doctors involved a half-hour phone intake in which she explained her situation. She was impressed with the fact that she spoke with a registered nurse – not an administrative lay person – who asked a “plethora of questions” in an effort to understand her case.  

Says Anne, “She was asking really intelligent questions which let me know she understood all the issues. She might not have had the answer at that point but she clearly understood what my dilemma was.” The nurse’s comprehensive questioning gave Anne confidence that her situation would be portrayed accurately. “How many times do you go to the doctor and the nurse asks you a million questions and the doctor comes in and you have to start all over again?”

Although initially a bit intimidated about signing a release that would allow all of her records to be accessed by the program, she agreed to do so after the nurse took care to go through the release with her and answer all her questions. Anne was told the process of evaluation and recommendation would take about five weeks. Although some might think it lengthy, the time it took to research her case convinced her that the process was extremely thorough. Throughout the five weeks Anne got weekly updates through the program’s secure site and was also urged to call with any questions.

“I probably only called them three or four times, but I tell you what – every time they weren’t there, I would receive a response within 24 hours.” Anne also emphasizes that throughout the process she was absolutely convinced her dealings with Best Doctors were kept 100 percent confidential and not discussed with her employer.

An unexpected recommendation
At the end of the five-week process, Anne received three different pieces of feedback from Best Doctors. The feedback came in written report form and although it contained some medical jargon, Anne claims the report was consumer-friendly and highly readable. Best Doctors then scheduled a report debrief with Anne within 48 hours so that the nurse could walk Anne through the information and answer all her questions, which is a mandatory component of the Best Doctors process to ensure the patient’s understanding. The report’s three sections of feedback included: a thorough diagnostic report of her condition, a summary of her treatment options along with pros and cons, and a list of physicians in the area that – depending on which course Anne took – were considered to be very good at the procedures included as options.

Anne’s treatment options included surgery, embolization and a third option which was one she hadn’t even considered. “They told me, ‘or you could do nothing – you’re 50 years old and a couple of years away from menopause, tough it out and once you reach menopause, you shouldn’t have any problems at all’,” Anne explains. However, because she’s a very active person and her condition causes her to suffer several other physical problems, Anne says she will probably go with one of the other two procedures. “I’m probably not going to go with the third option because I don’t want to wait two more years,” says Anne.

Unbelievably grateful
Anne has high words of praise for her experience with Best Doctors which left her with a strong sense of empowerment as a patient – allowing her to consider her own best course of action with utter confidence. Her sense of relief and gratitude for the patient-oriented process is palpable. “Let me tell you I was unbelievably grateful, satisfied, appreciative – I almost don’t know what words to say. I really felt like no stone was left unturned and I could make the most informed decision. I just believe that I’ve been given, truly, an expert opinion. And depending which option I ultimately go with, I’ve got my own physician, and some great names of doctors who are good at what they do and I can go from there.”

When asked what she would have done without Best Doctors, Anne says she probably would have just gone ahead with the surgery her doctor recommended but that it would not have been a comfortable decision for her. “I would have had doubts and I know a couple people would have been upset with me so it wouldn’t have been a very peaceful way to go into surgery. I probably would have done it just to get it over with.  I was too frightened about what I didn’t know, too paralyzed about what the right answer should be and I didn’t have enough time (to do the research),” she says.

What’s Anne’s opinion about the most valuable part of the Best Doctors program? In addition to citing that the program takes on all the legwork, is responsive and delivers a complete and thorough report, she goes on to say, “Quite frankly, there are more like ten most valuable parts about the program. It is a service I would have gladly paid for. I think clearly, they get it. When you don’t know which way to turn, knowing that these people really are experts from A to Z, is huge. I can’t count the ways it was really helpful.”

Anne has one last piece of advice – “If Best Doctors is available to you, run – don’t walk – to the phone, because the word ‘advocate’ will become real to you.”

*After a careful selection process, The Business Health Care Group (BHCG) contracted with Boston-based Best Doctors, Inc. as its informed decision making vendor in April of 2012.


Return to The Catalyst