Making Complex Decisions When Confronted With Conflicting Opinions

Dr. Ramesh, a dermatologist from Tirupathi, traveled to Chennai with his father-in-law, Mr. Subramaniam, who had been diagnosed with prostate cancer. It had been diagnosed at an early stage and there was a good chance that the right treatment could lead to a complete cure. Mr. Subramaniam was a fit 61-year-old who went for walks in the morning and was in great physical shape. He looked forward to beating the disease. Owing to the contacts of Dr. Ramesh, they were able to get appointments with two oncologists at a top private hospital in Chennai. They felt enthused that this trip would be successful and that they would get clarity on the path forward. After they met with the two specialists, the family seemed more confused than ever. The surgical oncologist recommended immediate surgery and the radiation oncologist opined that radiation followed by chemotherapy would be the recommended course of action. Even though both of these specialists were practicing in the same hospital, the patient needed to take separate appointments and the treatment advice was contradictory with neither consulting the other.

Cancer decisions are complex as they require multidisciplinary opinions.  Treatment plans need to be decided by a group of doctors who discuss and weigh the pros and cons of the various treatment paths. In a tertiary care center like Tata Memorial Center or Stanford Medical Center, a case like this would involve a decision being made by a tumor board. A tumor board typically consists of a diagnostic radiologist, pathologist, surgeon, medical oncologist and a radiation oncologist getting together in the same room to discuss the case. A decision is first taken on the diagnosis and staging of the disease where the pathologist and diagnostic radiologist weigh in. Once this is completed, the surgeon, medical oncologist and radiation oncologist decide on the treatment path. The intent is to recommend a path that will provide a complete cure or extend years of cancer free survival or improve quality of life. This can be possible through surgery if the disease is localized and operable. Sometimes the surgeon will suggest that the tumor be shrunk through chemotherapy or radiation and then the patient get operated. Having all relevant specialists weigh in and review the case is the ideal scenario but this is unfortunately not the modus operandi in most hospitals.

Given the contradictory paths presented to them, Dr. Ramesh decided to approach Tata Memorial Center. They became aware of the online opinion service available and registered on He uploaded all of his father-in-law’s reports following which a Navya clinical analyst reached out to him to not only understand the medical history but also all questions they needed answered. “We believed that we had gone to one of the best hospitals in South India and had met with two reputed oncologists. Even though I am a doctor myself, we were in a quandary as we were given contradictory opinions. Given this situation, we wanted to know from Tata Memorial Center how we should proceed in this case. Navya expedited our request and within 24 hours, we got a report that included the consensus of opinions from three experts including a surgical oncologist, a medical oncologist, and a radiation oncologist. The report was detailed and mentioned all of the treatment options and the reasons for recommended path. A clinical trial was also considered which gave us the peace of mind that no stone was left unturned.” The treatment recommended was to follow chemotherapy at this time and then consider definitive or curative therapy which could either be surgery or targeted radiation. The path was clear and the patient underwent a cycle of chemotherapy and the family heaved a collective sigh of relief.

Gaining access to even one oncologist can be challenging. Consulting more than one is often not possible, and even when it is, it takes up significant time. Given the criticality of timely treatment, the process of consulting several oncologists can be physically and emotionally draining and can lead to contradictory opinions which lead to confusion. To ensure that the treatment plan is comprehensive and is arrived at after considering all options, Navya processes cases by incorporating opinions of several experts from renowned cancer centers such as Tata Memorial Centre or expert centers such part of National Cancer Grid. Using Navya’s ExpertApp, case details and possible treatment options are sent to multiple experts who discuss the case online and build a multidisciplinary consensus opinion.

Says Dr. Abhishek Mahajan, a diagnostic radiologist at Tata Memorial Centre:”I am able to look at DICOM (Digital Imaging and Communications in Medicine) images to confirm the diagnosis and staging of the cancer. In some cases, there can be a question of the origin of the cancer. In one case, the treating oncologist needed to know whether it was a case of liver cancer or if it was a cancer that had spread to the liver.” The therapies recommended for each of these cases could be very different.

“Treatment decision making in oncology is essentially a joint discussion between all care givers, aiming towards the best course forward for the patient. At times, only surgery and radiation may suffice without chemotherapy, or chemotherapy and radiation can make surgery easier, and at times single modalities of treatment like chemotherapy or radiation may be all that the patient requires. What matters most is the optimal timing and selection of right modality of treatment. Navya, through the online ExpertApp, brings together a nuanced consensus from opinions of all the experts, in a language and manner understandable to all stakeholders, thus the best possible care for the patient” says Dr. Tushar Vora, medical oncologist at Tata Memorial Center.

Urging family members of cancer patients, Gitika Srivastava, Founder of Navya, shares her personal viewpoint:  “Most people who have had any experience with cancer are aware of TMC and that it is one of the largest tertiary care centers in the world. However, not everyone from far flung areas can come to Mumbai or is aware of the significance of a proper choice in treatment to a change in outcomes. Given the cases we have seen, we would urge everyone to get an expert opinion online at  You can be assured that the opinion rests on the experience of world renowned cancer experts and follows evidence based protocols best suited to your loved one’s specific case.”

National Cancer Grid (NCG), Tata Memorial Centre (TMC)

The NCG is a consortium of 104 cancer centers, with a mandate to standardize cancer care, nationally. NCG is the largest global network of cancer centers collaborating to use technology and training to bring cancer expertise to every oncologist and cancer patient in India. TMC is Asia’s largest leading tertiary care expert cancer center, seeing over 67,000 cancer patients every year. Its strength necessitates a responsibility to make its expertise available to patients across India and developing countries, especially those who reside in locations where there are no expert cancer care centers.


Navya is a clinical informatics and patient services organization with a unique understanding of cancer patients and oncologists and a core commitment to cancer care. With a proven track record of successfully implementing innovative solutions that are low cost and effective, Navya is the first to develop technology systems specific to Indian cancer data for use by cancer patients and oncologists in India.  Contact:  Gitika Srivastava |




Expert Opinion for Cancer Care in 24 Hours


TMC NCG Online – Navya Expert Opinion Service empowers patients with critical information within 24 hours enabling families to make robust decisions in cancer care with adequate inputs from oncologists at Tata Memorial Centre and National Cancer Grid (including cancer centers like AIIMS, Kidwai, Max Hospital, etc.). This service, available at, allows patients to upload their reports and get a response from world renowned experts.

Families seek to vet treatment plans with experts but it can be challenging as doctors often recommend the treatment start immediately to prevent cancer from advancing. Balancing the need to act quickly while ensuring the decision is made with all relevant inputs is when Navya’s Online Expert Opinion Service becomes a powerful ally.

While diagnosing the presence of cancer can be relatively straightforward, treatment is highly specialized and the number of experts experienced in managing complex cases is very few. Many cancers are curable or can be managed for a number of years if diagnosed early and treated appropriately. Choosing the right therapy can be the difference between the best possible outcome and failed treatment. Patients are able to receive the best possible treatment opinion which includes what therapy to choose (surgery, chemotherapy, radiotherapy or immunotherapy) as well as dosage, duration, side effects and other details pertinent to the treatment. The detailed report, that answers all questions asked by the patient in language that is simple to understand, can then be shared with the local oncologist to proceed with the treatment locally.

Maya Fonseca, 27, of Goa had a situation where following a routine checkup and follow up tests, her mother was diagnosed with stage IV cancer. The tests administered at the time were inconclusive as to the origin of the cancer. A slide review was recommended which would have taken 14 days but the treating oncologist advised that chemotherapy be commenced immediately. Maya and her family were understandably unsure of how and when to proceed with treatment. She reached out to Navya Online Expert Opinion Service and uploaded the reports. Navya’s patient advocate called her, got a thorough understanding of the case and noted all the questions that she wanted to ask the expert. The medical history along with evidence based treatment options were presented to an expert using Navya’s patented system for an opinion. The experts at Tata Memorial Centre were able to conclude that the medical reports and clinical history were consistent with cancer of the ovaries and chemotherapy was the next step followed by surgery.   On receiving the expert’s response, a report was created that answered all questions asked by the patient in language that was simple to understand. With the treatment opinion that included the chemotherapy, dosage and frequency, Maya’s mother was able to proceed with immediate treatment safe in the knowledge that she was making the right decision.

Urging families of cancer patients, Gitika Srivastava, Founder of Navya, says: “Most people who have had any experience with cancer are aware that given time and logistical constraints, it is not always feasible to go to tertiary care centers in metropolitan cities at each treatment decision point. Given the importance of treatment decisions in yielding the best possible outcomes, we would urge everyone to get an expert opinion through TMC NCG Online. We understand the anxiety in knowing what to do as quickly as possible, and hence have strived to ensure that we facilitate the opinion from the experts within 24 hours of getting all necessary medical reports. When making a decision on treatment, you and your oncologist can be assured that the opinion rests on the experience of world renowned cancer experts and follows evidence based protocols best suited to your specific case.”

Online Expert Opinion: Navya.Care

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Tata Memorial Center:  Facebook

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Data Driven Doc: As Easy As ‘Tak, tak, tak’


Early on in creating Navya- Gitika and I met with the CEO of a private hospital in Mumbai exploring interest in Navya’s expert opinion services. He dismissed us offhand- saying he could email his friends ‘tak, tak, tak’ (Indian/Desi colloquialism for ‘instantly’) and get a response from them on any questions he had. Funnily enough – he was a radiologist who didn’t see the power of asynchronous and instantaneous collaboration on medical information. Today teleradiology is one of the largest medical services online.

A few years later, I’m impressed with how many ‘tak, tak, tak’ connections Navya has created for our patients across the world. We had 20 requests for consultations today, and we were able to get instantaneous reviews of many of the cases by international experts.  Where one expert’s response wasn’t confident enough, we got two or three to confirm! Back to the patient in a day!

A well-connected CEO of a hospital may get his medical questions answered by specialists in a jiffy, but the true value of Navya on democratizing expert information across the world, instantaneously, is beautiful. It’s truly as easy as ‘tak, tak, tak’.

-Dr. Naresh Ramarajan

Online Expert Opinion:
Tata Trusts:
Tata Memorial Center: