Remote Consultations in Germany

msp group germany provides remote consultation services for patients who wish to obtain the expert opinion of leading German specialists.

Of course, in some cases that require an in-person examination of the patient, a remote consultation is not entirely the right option.

Please note that the provision of various forms of online consultation by staff of public healthcare institutions conflicts with the telemedicine regulations currently in force in Germany. Remote consultations are permitted only for the ongoing care of patients who have been examined in person by a doctor and have signed a telemedicine agreement. This does not mean that doctors at public hospitals are forbidden to issue written opinions. However, staff of private clinics are permitted to hold video consultations.

Once you have provided us with translations of your medical reports, laboratory test results, histology findings and radiological studies (MRI, CT, X-ray, etc.), chemotherapy and radiotherapy protocols, the recommendations of your treating doctors and so on, you should set out all your questions, doubts and expectations, and describe your current symptoms.

The doctor will always require a detailed interim medical summary of the illness setting out precisely the history of the primary and concomitant conditions, together with information on the patient's current clinical status and complaints.

Please note: all questions for the doctor must be clearly formulated. The expert doctor prepares all comments and recommendations on treatment and disease monitoring in accordance with the telemedicine legislation currently in force in Germany.

The cost of a remote consultation is from 250 € to 750 € + 19% VAT.

Processing of the request — within 8-14 working days once the complete set of documents, including their professional translation, has been assembled.

The approximate prices quoted do not include the written translation of medical reports, test results and specialist opinions.

The cost of the consultation depends on how much time is spent on it and on whether specialists from other fields have to be involved: a gynaecologist, for example, sometimes brings in a gynaecological endocrinologist to help draw up the report, an oncologist — a cardiologist or an orthopaedic surgeon, a neurosurgeon — a neuroradiologist, a dermatologist — a rheumatologist.

The cost of a remote consultation also includes our services:

assessing whether a remote consultation is appropriate and determining its format;
selecting a specialist who is able to advise the patient promptly;
compiling the set of documents;
drafting the request to the chosen specialist;
technical support (downloading images, providing an interpreter for the video consultation, etc.).

Advantages of a remote consultation

savings of time and money on travelling to Germany and the associated overheads (visas, accommodation, transfers, meals, medical interpreting services, etc.);
assessment by the best and thoroughly vetted clinicians;
time saved waiting for an in-person consultation (it is no secret that an appointment with a world-class doctor takes between 1 and 6 months to obtain).

A remote consultation is provided after the invoice-contract has been paid and solely on the basis of an informative, up-to-date and complete set of documents and good-quality images.

How does msp group germany help?

1. Assessing whether a remote consultation is appropriate

After reviewing your documents, our consulting doctor will tell you whether a remote consultation makes sense and, if it is not feasible, will try to suggest another option, for example an in-person consultation.

2. Assessing how informative and complete the medical information provided is

A large volume of scattered, low-information medical documents does not in itself mean they are informative enough for an expert medical review. We will tell you what information is missing.

3. Preparing the set of medical information

We have hardly ever come across a correctly drafted request for a remote consultation. Our task is to go into the details of every request, to formulate your questions to the consulting professor clearly, and to ensure feedback between doctor and patient if the doctor needs additional information or further examinations. Only a carefully prepared treatment request will have maximum effect.

4. Help in choosing the format of the remote consultation

A live dialogue with a German consulting doctor in real time is very appealing. Nevertheless, this form of expert assessment is not always the best one. It depends not only on the nature of the problem, but also on the working arrangements of the particular specialist or medical institution. Taking all these details into account, we will recommend the most suitable format of remote consultation for you.

5. Help in choosing a doctor for the remote consultation

Our website contains information about leading experts in a wide range of clinical specialities. Once you have read it, you can state your preference for the consulting doctor who will assess your case.

6. Help with settling payments with the consulting doctor.

We will find out the cost of the specific consultation, which depends on the time spent on it and on whether other specialists need to be involved in preparing the report in a complex interdisciplinary case.

7. Technical support

We will take care not only of the necessary processing of information on digital media and of good-quality audio and video connections, but also of information security rules in line with current EU legislation on the processing and storage of personal data.

8. Interpreter support

We will arrange a professional written translation of your medical documentation into German and provide interpreting during online consultations.

HOW TO ORDER A REMOTE CONSULTATION IN GERMANY

STEP 1

To order a remote consultation in Germany

1. send us a request stating your first name and surname, full date of birth, diagnosis, contact telephone number and e-mail address to info@msp-ger.com, via WhatsApp, Viber or Telegram, or use the contact form on the "Contacts" page. For a remote consultation it is essential to provide good-quality images (the results of diagnostic imaging) and test results. Otherwise, costly diagnostic procedures that are sometimes not good for your health will have to be repeated. Contact us and we will advise you on where to have imaging carried out to an impeccable standard.

Send us all the information listed above and, once we have confirmed that a remote consultation is possible, we will inform you of its cost and of the next steps.

STEP 2

We will contact you within a few hours to discuss the purpose of the remote consultation and all the questions you would like to have clarified. By e-mailing us your medical reports, you thereby grant us the right to pass them on for expert assessment to the doctors involved in preparing the remote opinion. If you do not have translations of your medical reports, test results and specialist opinions into German or English, we will translate them into German ourselves and prepare the complete set of documents for the expert review.

Staff at msp group germany will begin processing your request to arrange a remote consultation as soon as the funds reach the company's account.

Please note! Medical reports and images must be current (no older than 3-6 months).

Please note! Many clinics and specialists insist on being given the original CD with the results of the diagnostic imaging. You can send the CD with the images to our postal address or have it delivered by hand. German university hospitals do not open any links to cloud storage and do not accept non-original discs for review. In exceptional cases, for an additional fee, we will download the images and pass them on to the specialists.

STEP 3

Once we have received the complete set of documents, we inform you of the estimated cost of the remote consultation and of the name and qualifications of the specialist. You then pay the invoice issued in your name by bank transfer.

Within 7-14 working days you will receive a written opinion from the expert doctor. The result of the consultation is provided to the patient in German together with an English translation.

Please note that if the patient subsequently comes to Germany for treatment on the doctors' recommendation, the amount already paid will be credited towards the total fee for arranging the treatment.

COST OF REMOTE CONSULTATIONS

A remote consultation costs from 250 to 750 euros + VAT.

In addition to the expert's fee, the cost of a remote consultation includes our services:

assessing whether a remote consultation is appropriate and determining its format;
selecting a specialist who is able to advise the patient promptly;
compiling the set of documents;
drafting the request to the chosen specialist;
technical support (downloading images, providing an interpreter for the video consultation, etc.);
translation of the expert opinion into English.

The fee charged by the consulting professor depends on the volume of medical documentation provided and the number of digital media, as well as on the complexity of the case, for example on whether specialists from other fields need to be involved.

TYPES OF REMOTE CONSULTATION

remote review of biological material (second reading of slides and paraffin blocks);
remote consultation with doctors (written remote opinion);
review of chemotherapy protocols;
review of palliative care protocols;
review of radiotherapy protocols;
review of drug therapy plans;
assessment of MRI, CT, PET-CT, X-ray, mammography and other images (interpretation of radiological findings).

YOUR CLEAR ADVANTAGES

A remote consultation is an opportunity to:

save money on flights, tickets, hotels and the cost of an in-person consultation;
save time waiting for an appointment with a world-renowned specialist;
hand over to us the routine work of communicating with doctors and translating medical documentation;
receive recommendations from leading German clinicians based on the achievements of modern evidence-based medicine;
learn about alternative and gentler treatment methods;
avoid unnecessary surgery or excessive diagnostic testing.

REAL-LIFE EXAMPLES OF REMOTE CONSULTATIONS

EXAMPLE 1
EXAMPLE 2

Background

Patient S.S. from Krasnodar, Russia, contacted us asking for an expert second opinion in order to determine the further treatment strategy for a cranial nerve tumour (diagnosis: acoustic neuroma of the left VIII nerve). In her home country she had been offered various treatment options, namely surgery, radiotherapy and radiosurgery with the CyberKnife system.

Choice of specialist

To draw up expert treatment recommendations we turned to Prof. Dr. med. Roland Goldbrunner. Prof. Goldbrunner is President of the German Society of Neurosurgery (Deutsche Gesellschaft für Neurochirurgie — DGNC). He is Head of the Department of General Neurosurgery at the University Hospital Cologne (Germany) and Managing Director of the Centre for Neurosurgery in Cologne.

We chose Professor Goldbrunner because his main areas of specialisation are neuro-oncology, neurosurgery and skull base disorders. He has drawn up guidelines for the treatment of various neurosurgical conditions and is the author and co-author of more than 160 scientific papers published in international journals.

In addition, Professor Goldbrunner has for many years been included in the ranking of the best neurosurgeons in Germany compiled by the independent magazine Focus. He received the award for the best specialist in the treatment of brain tumours for 2019 (Top-Mediziner 2019 Hirntumoren).

Documents submitted

The expert opinion was drawn up on the basis of the patient's own medical history as submitted, together with MRI scans with and without contrast.

Questions formulated by the patient

What treatment strategy is recommended, taking into account age, clinical condition and tumour location? What are the chances and risks of the proposed treatment options? What is the likelihood of recurrence in the future?

The specialist's recommendations

In this situation, namely with a vestibular schwannoma of about 1.5 cm, CyberKnife or Gamma Knife treatment is usually recommended. However, the results of long-term follow-up show that about 10 years after this treatment most patients who previously had no hearing impairment lose their hearing. For patients who are not elderly and have no hearing impairment, we always recommend surgery.

In principle both of the methods mentioned are possible — surgery and radiotherapy. The advantage of surgery is that the tumour is removed quickly (or at least reduced substantially in size). However, surgery carries an increased risk of facial palsy due to damage to the facial nerve (N. facialis) and of hearing loss (if functional hearing is still preserved in that ear). In rare cases repeat intracranial bleeding and inflammation are observed. Radiotherapy halts tumour growth and reduces its volume over the following years. In the first phase after irradiation swelling may occur, and tinnitus and dizziness may also increase. Paresis is observed in 0.5% of cases. The main risk of radiosurgery with the Gamma Knife is that hearing loss occurs in 30-40 % of cases

If the patient heard very well before the disease developed, I would recommend surgery; however, given that the tumour is extremely small and that schwannomas grow very slowly, I would recommend that the patient be followed up with MRI monitoring every six months.

Our hospital can offer the patient both treatment methods.

Yours sincerely,

Prof. Dr. med. Roland Goldbrunner

President of the German Society of Neurosurgery (DGNC)

Managing Director of the Centre for Neurosurgery

Head of the Department of General Neurosurgery

University Hospital Cologne (Germany).

The cost of the remote consultation in Germany was 450 euros.

The cost of translating the medical documentation was 180 euros.

Background

Patient T.N. from Nizhny Novgorod, Russia, contacted us asking for an expert second opinion in order to review the diagnosis made at a private dermatology clinic in Munich (angioedema) and then in Nizhny Novgorod (stress and a reaction to cold). The patient suffered from severe swelling of the face; in Munich she was prescribed and underwent an expensive genetic test, and at home she was prescribed a variety of tests (including microscopic examination of stool for helminth eggs), injections, cortisone-containing ointments such as Dexamethasone® and other glucocorticoids, and antihistamines.

Choice of specialist

To draw up expert treatment recommendations we turned to PD Dr. med. D. Höller Obrigkeit (Praxisklinik für Dermatologie, Allergologie am Luisenhospital Aachen); specialisation:

We chose PD Dr. med. D. Höller Obrigkeit because her main areas of specialisation are dermatology, allergology, the treatment of skin cancer, psoriasis and autoimmune diseases, trichology and the treatment of sexually transmitted infections. She is the author and co-author of more than 50 scientific papers published in international journals, takes part in clinical trials and acts as an expert for many pharmaceutical and cosmetics companies, including the cosmetics company Babor.

In addition, PD Dr. med. D. Höller Obrigkeit has taught for many years at the Faculty of Medicine of RWTH Aachen University.

Documents submitted

The expert opinion was drawn up on the basis of the patient's own medical history as submitted, together with photographs and the reports from the dermatology clinic in Munich.

Questions formulated by the patient

What further diagnostic work-up and treatment strategy would you recommend? Is there a chance of helping me, or do I have to live with this forever?

The specialist's recommendations

In the specialist's opinion, the diagnostic recommendations made by the doctors at the private dermatology practice in Munich and the tests carried out in Munich and in Russia do not allow any conclusions to be drawn about the cause of the swelling. The work-up performed was incomplete. To establish the cause of the condition, the following additional examinations are required:

1. a urea breath test for Helicobacter pylori; 2. a comprehensive blood test (IgE) for various food, inhalation and household allergens; 3. a blood test for hidden food intolerance; 4. where indicated, and after a full medical and personal history has been taken, skin prick tests with various food, inhalation and household allergens.

In the doctor's assessment, the swelling shown in the photograph cannot possibly be classified as angioedema. Swelling of that origin does not respond to Dexamethasone® or other glucocorticoids.

To relieve the swelling around the eyes, Dr. Höller Obrigkeit recommended the cortisol eye ointment Ficortril Augensalbe 0.5%; for other areas of skin — Protopic® ointment 0.1%. These topical ointments are symptomatic treatment. In order to treat the condition or eliminate contact with the provoking substances, a full work-up by a dermatologist-allergologist working with certified laboratories is required.

PD Dr. Höller Obrigkeit also said that she would be glad to provide highly qualified help in establishing the cause of the swelling. At this stage, having reviewed the complaints and the nature and location of the swelling, she suspects a reaction to some cleaning or washing product.

Message from the patient: the test for Helicobacter pylori was positive, as were the inhalation tests for cleaning and washing products. After eradication of Helicobacter pylori and avoidance of contact with the allergens, she was completely rid of the severe facial swelling.

Patient T.N. did not need to travel to Germany.

The cost of the remote consultation in Germany was 250 euros.

The cost of translating the medical documentation was 80 euros.

EXAMPLE 3
EXAMPLE 4

Background Patient T.B. from Moscow, Russia, contacted us for an expert assessment of MRI scans; in the complete absence of any symptoms, an abnormality had been found incidentally on images of the cervical spine at the level of the 4th/5th cervical vertebra

Choice of specialist To draw up expert treatment recommendations we turned to Prof. Dr. med. Hans Clusmann, Head of the Department of Neurosurgery at the University Hospital Aachen. Professor Clusmann is President of the Neurosurgical Academy (NCA) of the German Society of Neurosurgery (DGNC), head of the certification committee of the German Society of Neurosurgery, and a member of the German Society of Neurosurgery (DGN) and of the Professional Association of German Neurosurgeons (BDN). Prof. H. Clusmann has received numerous scientific awards, among them the Hans Imhoff research prize of the Faculty of Medicine in Cologne (1998) and the incentive prize of the neurosurgical research foundation of the German Society of Neurosurgery (DGNC) for 2001; he is the author of more than 50 monographs and publications in national and international medical journals.

Specialisation Surgical treatment of tumours of the brain and skull base, including with neuronavigation and intraoperative monitoring; skull base and pituitary surgery; vascular neurosurgery; surgical treatment of epilepsy; paediatric neurosurgery, including endoscopic surgery for hydrocephalus; treatment of traumatic brain injury; degenerative diseases of the spinal cord as well as disorders of the cervical, thoracic and lumbar intervertebral discs with damage to the nerve roots or the spinal cord; benign and malignant tumours of the spinal cord and spinal canal and injuries; peripheral nerve tumours; minimally invasive treatment of degenerative spinal disease, e.g. osteoporotic vertebral fractures; spinal neurosurgery; endoscopic reconstructive operations on the spinal cord and complex spondylodesis; intensive care

Documents submitted Reports on the MRI scans, MRI images on CD-ROM. No information about the patient's medical history was provided to us.

Questions formulated by the patient Please assess the MRI scans. Three specialists in Moscow consider the lesion to be a tumour; one professor concluded that it is an inflammatory process

Current assessment of this case The MRI scans of the cervical spine (with and without contrast enhancement) dated 11.09.2019 show an intramedullary tumour measuring 7x7 mm displaced to the left at the level of the 4th/5th cervical vertebra, located dorsolaterally and taking up contrast medium, accompanied by oedema extending from the level of the 3rd/4th to the 6th/7th cervical vertebra. The images provided do not include a view showing contrast uptake in the axial plane. An ependymoma is suspected.

Conclusion and recommendations If the patient has none of the complaints listed below (cervicobrachialgia, sensory deficits, and also abnormal sensations such as numbness, tingling or a crawling sensation in the arms or legs, especially on the left side, as well as motor impairment, bladder and bowel dysfunction, gait disturbance, ataxia (impaired coordination of different muscle groups during voluntary movement) and others), we recommend a repeat follow-up MRI with and without contrast in 3 months; the images on CD can again be sent to our department for an opinion. The presence of one or more of the symptoms described above is an indication for biopsy or resection of the tumour.

If the patient decides to undergo surgery, we ask you to arrange an appointment with Prof. Clusmann during his consulting hours for private patients. If there are no surgical complications, the hospital stay will last approximately 10 days.

We will be glad to answer any questions you may have.

Yours sincerely,

Prof. Dr. med. H. R. Clusmann Head of the Department of Neurosurgery, University Hospital Aachen

The patient hesitated for a long time before agreeing to surgery, but as specific symptoms increased he travelled to Germany and was operated on by Professor H. Clusmann in Germany. The preoperative tumour biopsy confirmed the professor's conclusions. The patient did not require chemotherapy or radiotherapy. Patient T.B. is advised to have follow-up MRI monitoring.

The cost of the remote consultation in Germany was 450 euros.

The cost of translating the medical documentation was 150 euros.