Second Opinions

What Are Medical Second Opinions?
Who Benefits from Having a Second Opinion?
Why Is This Service Important?
What Services Are Provided and What They Cost?

What Are Medical Second
Opinions

Drs. Bagheri and Talieh have both served as the lead physicians in several
different clinical settings ranging from directing intensive care units to geriatric
programs for major medical group, hospice re-organizations as well as running
home care programs in major metropolitan areas. This means than when other
physicians in the group encountered complex cases, patients with puzzling and
unusual health problems and failure to respond to standard therapies they would
refer their cases to us for a second opinion.

Physicians who call us are at times younger, less experienced physicians who are
encountering their first major complication or puzzle they can not quite fit
together. At times the physicians have the same if not more training and experience
than we do. However, as we have discovered through our own experience in
supervising other physicians the unique ability to navigate the complex maze of
symptoms, findings, lab and radiographic tests and the differing opinions from
different sources has little to do with education, training or experience level. It
requires a unique mix of talent, ability, interest and open-mindedness. Of course, as
with any professional exercise, specially medicine, caring about the outcome and
the determination to find the answers and help another individual is the primary
characteristic that allows us to provide the service we are offering here effectively.

All cases referred to us for second opinions are reviewed by both physicians in great
detail. Additionally, they are further reviewed in weekly meetings with Dr.
Conway in order to obtain a different perspective (naturopathic approach) on
diagnosis and treatment of these complex cases. Subsequently, all opinions are
transcribed and sent to you with appropriate recommendations for further testing
or treatment. Although we can not provide treatment without actually seeing the
patient and becoming the treating physicians we can provide valuable opinions
that can be subsequently shared with your physicians. We can however proceed
with facilitating appropriate testing or recommending supplements that may be
highly effective in reaching a final diagnosis or treating a suspected condition.  

Opinions are almost always sent to you within one week of receiving your records.
Responses will be elaborated in simple, easy to understand terms so you can
completely comprehend our opinions regarding your condition. In addition, a
concise summary of our conclusions will be included so that you can share our
impressions of your condition with your health care providers.

We sometimes recommend further laboratory or radiographic testing that you may
again recommend to your healthcare providers. frequently, we can also order these
tests for you. We also provide the option for you to submit your blood, urine, saliva
or hair samples for analysis in our CLIA certified state of the art laboratory
facilities at your discretion.

Who Benefits from Our Services

Virtually anyone can benefit from our services. Even the healthiest of individuals who just
went to his/her annual physical and had a borderline abnormal cholesterol level can benefit
from having a second set of eyes evaluating the borderline abnormal lab test. Question
would be if there is any further intervention or testing that can improve long term outcomes
and/or was th eoriginal test interpreted and treated appropriately or not. Another
individual who is basically healthy but takes one or two medications for mild, chronic
disorders can benefit from having a second look at his/her medical issues to see if she can do
without the medications or have further work up to discover and treat the underlying
disease rather than being subject to taking medications long term to treat the symptoms of
the disease. Of course, the most complex and challenging individuals usually suffer from
many ailments, likely related to oe another, and take multiple medications and treatment
every week. These individuals could benefit most from getting a second opinion since their
illness has taken the highest toll on their lives and can make the most impact.

Why is this service Important?

Many individuals with complex medical problems end up spending an inordinate amount of
time going from one physician’s office to another, from one lab to another, from one imaging
center to another only to end up frustrated. At the end of the day either the diagnosis has
been incorrect all the while, the treatment suboptimal or the necessary tests never ordered to
reach the correct diagnosis. In the process the life of  the individual has been altered and a
once normal life has been transformed to that of a “patient”.

The downside of going to multiple specialists would be that if  they are a hammer they will
treat you as a nail. If you suffer from fatigue and you go see a Lyme specialist, then you are
likely to walk out with the diagnosis of Lyme. If you suffer from fatigue and see a
mitochondrial specialist then with all the same symptoms and lab results you will get a
diagnosis of mitochondrial damage. If you see a neurologist with special interest in MS then
you get a diagnosis of MS and if you see one with special interest in myopathy you get
needles placed in various parts of your body and have an electromyogram and get a diagnosis
of myopathy. All the while all treatments for these conditions are long term, toxic and often
unrewarding except in making you a long term patient. In the process transforming the life
of a previously healthy individual into a long term/full time “patients”.

We hope that our services will provide some continuity by integrating all aspects of care and
providing a concise view of our clients’ condition once all the aspects of care and testing
have been summarized. It is difficult for even the best of physicians to provide an objective
diagnosis when they have been seeing a patient for years. They often get locked into the
impression they had on day one that may have been confirmed by consultants and specialists.
Many incorrect diagnoses are the result of one opinion generated on one occasion
subsequently perpetuated blindly by everyone who followed. In today’s busy medical
environment where physicians have to see 20-30 patients a day it is often easiest to go with
the flow and not rock the boat.   

We do not misrepresent ourselves. We offer opinions and not actual treatments. We would
be happy to provide direct care for patients who come to our clinic but we can only render
recommendation through our Internet service.  Your physicians would have to comply with
our recommendations before you can get the tests or medications we recommend. An
exception to this rule would be if testing were done in our lab or in facilities in and around
San Luis Obispo California where we practice and have privileges as providers.  

Services we provide

Simple laboratory test review and evaluation: This is the most basic service we provide and
involves evaluation of one set of laboratory test results and commenting on the appropriate
management based on these lab tests alone without considering any other variables. This type
of limited evaluation is best suited for simple medical problems such as isolated elevated
cholesterol, anemia, borderline elevations of liver enzymes and other simple laboratory
abnormalities. This is best suited for those who are basically healthy but have an abnormal
blood test. Cost for consultation $100.

Complex laboratory test review and evaluation:  This is the next level in laboratory test
evaluation with review of several sets of laboratory tests to be evaluated over time. This
would also include a one paragraph summary provided by the patient describing ongoing
symptoms and signs that he/she is experiencing. Cost for consultation $250

Complex review of history as well as laboratory and radiographic testing:  complete medical
records to be provided by patient will be reviewed in detail. All labs, X-rays, EKG’s and
other information provided by patient will be reviewed by physicians individually and then
discussed in a group meeting. Feedback will be provided by one of the physicians in writing
within a week of receiving medical records. $500

Complex review of history as well as laboratory and radiographic testing as well as obtaining
medical history and information from up to two sources: All above services but in addition
we will take responsibility for obtaining medical records from two different sources. This
will require a written consent from you authorizing us to obtain these records from hospitals,
labs, imaging centers, physician offices, … $750 plus any fees required by these facilities to
release records.

Complex review of history as well as laboratory and radiographic testing as well as obtaining
medical history and information from up to two sources and compiling all information on CD
for future reference: $1000 plus any fees required by these facilities to release records
Obtaining medical history and information from up to two sources and compiling all
information on CD only: $250

Case Management: $500 a month