Traveling for Healthcare – What Should You Do?

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By Stewart M. Hamilton, M.D., C.M.O., The Medical Travel CommissionThe decision to travel to seek medical care is not insignificant and may well be life-changing! There are many reasons to go, many to stay. This article is a brief synopsis of some of the thoughts and considerations that should occur before making that decision. Why go? Cost is often the principal reason. Do not forget that the cost of the procedure may be but the tip of the iceberg. There are travel expenses, often for yourself and a companion. What about post-operative recuperation? Is it a requirement of the surgeon that you stay close at hand in the initial days, or perhaps months, after surgery? Where do you stay? How much will it cost? What happens when you get home? Who will take care of any post-operative complications? Do remember that physicians in your home area may not be willing to get involved in another physician’s complications for reasons that include the malpractice risk, and because they might not know exactly what has been done and how it has been done. Increased privacy is often a reason to go, as is the chance to take a vacation in a better climate. A shorter wait prior to a procedure may be another driving force. Each of these reasons has validity, but should always be added up and judged carefully against the potential problems that care overseas might bring. Assuming that you have resolved any financial concerns, there are more potential issues to weigh. Let us try and address the ones that can significantly impact your care and which you should really try and resolve. Some would apply whether you choose to travel for care or remain at home. What is the reputation of the hospital or clinic that you are considering? This should be easier to evaluate in your own country, but across international borders may be more difficult. Simply surfing the Internet may yield clues. Check newspapers close to the locale to which you are considering traveling, if they are available and can be translated / understood. A more reliable and objective means may be to look for accreditation by national or international bodies which have principal concerns related to quality and safety of care delivered in an institution. The Joint Commission International (JCI), based in the US but accrediting hospitals and clinics in some 60+ countries worldwide, is probably the best known and has the most accredited entities. But there are certainly others based in Britain, Canada and France, to name but a few countries. Only a handful of these however, visit and assess hospitals internationally. Accreditation, for example by JCI, demonstrates, at a minimum, an institutional commitment to quality and safety and a medical staff that has been carefully vetted, assessed and re-assessed as far as qualifications, quality of care and current competence. This does not, however, necessarily mean that an individual physician has carried out a large number of the particular procedure. Nor does quantity necessarily mean excellent and consistent outcomes. As a prospective patient you need to be sure that your surgeon has the appropriate experience and that his or her outcomes are favorable in terms of survival, success, length of stay, complications and patient satisfaction. Any institution or surgeon should be more than happy to provide such outcomes, which can be compared to colleagues on a regional, national or international basis. I would avoid those institutions or physicians unwilling or unable to provide such data. Note that patient satisfaction is also an outcome. Satisfaction, in a general sense, is achieved when expectations are met. What are your expectations when you visit a physician, clinic or hospital? I am sure that high among your expectations is a successful operation or procedure. Incidentally, physicians rarely assume a successful operation, procedure or diagnostic work-up. They expect that it will be the case, but it is rarely assumed. In light of the fact that a successful procedure, operation or work-up is presumed by most patients, for many the “softer” side of medical care is what drives satisfaction, as long as the procedure/treatment goes as planned. Ask yourself what would be your expectations beyond a successful intervention away from home. Were arrangements made for you to get from the airport to comfortable accommodations? Were your dietary needs met? Were you able to speak with your principal physician before you left home? Were your concerns and questions answered? Do you feel that you were listened to and treated with respect? Post surgery or procedure, were you able to contact your caregivers? How were your traveling companions treated? Were your doctors prompt? Did they examine you? Did the hospital or clinic make sure that you were able to communicate with them when away from home? Were you provided with a summary of your hospital stay and any tests as you were discharged? Were arrangements made to ensure your safe trip home? Were you given enough medication to ensure a pain-free recovery period, including the journey? As a prospective patient looking at websites and brochures it can be difficult to assess whether such expectations are likely to be met. But they are the very things from which a patient will derive satisfaction. While accreditation by JCI and other such bodies affirms a commitment by a hospital or clinic to quality and safety, accreditation by the Medical Travel Commission (MTC) assures that a hospital or clinic addresses each of the above “softer” aspects of care (and more). The MTC, founded and led by highly experienced international healthcare professionals, began accreditation activities in the US in hospitals that provide care to international and intranational patients in 2012, and is now expanding internationally. The MTC standards are rigorous – and all must be met to achieve accreditation. The Rehabilitation Institute of Chicago, the Texas Medical Center – Memorial Hermann Hospital, the Moffitt Cancer Center in Tampa, and the Mount Sinai Hospital in New York are prime examples of world-class institutions that have departments totally dedicated to the medical traveler. They are also examples of hospitals that have met all of the rigorous standards of the MTC, and as such, provide the very best of care to their patients who have travelled for care. Any institution that attains the MTC accreditation joins a group of world-class hospitals providing world-class care specifically tailored to the needs of those patients who travel for their medical care. A comparable award might be that of a Michelin Star or Zagat rating. Passing inspection by the local Health Department by the local Health Department implies a certain degree of cleanliness and safety but a Michelin Star or Zagat rating implies a great deal more and, in particular, includes a superior ambiance, trained staff, and customer satisfaction along with great food. An MTC rating of a hospital that has been accredited by JCI brings the same implication of quality, safety, ambiance, communication and cooperation, and most important a dedicated department focused on the well-being and safety of the travelling patient Beyond quality, safety and patient satisfaction what other questions need to be considered and answered? Where are you willing to go? Within your own country or internationally? If the answer is internationally then consider that there may be cultures and customs in some parts of the world that may make that country or region less desirable to some, more to others. Remember that you are most likely to be spending time in that country before and after your treatment. Are there significant language issues? If the worst occurs, would the staff follow your advance directives or the wishes of whoever has power of attorney for you? Is insurance available to cover unanticipated cancellations, returns or family issues? Will I need a passport and or visa? What, if any, arrangements will need to be made for your return with casts, implants and wheelchair? Do you intend to recuperate post-procedure close to where you had your treatment? If so, where do you plan to go and what are the available facilities? Does the medical facility take all comers or do they, in fact, really screen patients. You do not want to travel only to be rejected or to realize that your surgeon has only done a handful of the procedures that you need. You also really do not want to find a physician that does not know his or her limitations, and who is willing to take any and all patients. All of the above are issues, ideas and considerations to be taken into account. Travelling for medical care should not be undertaken without plenty of thought, but can be, and is, undertaken by thousands of patients each year with great success. Having said that, there may be reasons making medical travel less desirable for a particular individual. Generally speaking, if you are otherwise healthy and traveling for care of relatively simple and straightforward issues, aiming to reduce costs and or combine care with a vacation, then once you have considered the quality, safety, satisfaction and cost issues outlined above go ahead and make plans. However, if you have a complex medical history and multiple medical problems you really must give very careful thought as to whether it makes sense to seek care far from home and family, particularly internationally. It is an unfortunate reality that there may be difficulty in finding a physician willing to take over your care at home should you be unlucky enough to return with complications from a surgical procedure for which you have travelled outside your own country. For the most part, physicians fear taking care of another physician’s complications and being drawn into subsequent malpractice. Although perhaps for fear of hurting feelings, you may be reticent to discuss leaving your home medical community with your personal physician, it is extremely important when you have multiple medical issues and/or a chronic disease, such as diabetes or Chronic Obstructive Pulmonary Disease (COPD), to speak to a medical professional before committing to medical travel. Risks are all relative, but without adequate background medical knowledge it is very difficult for the average lay individual to make a rational decision as to the degree of medical risk. For example, poorly controlled diabetes greatly increases the risk of post-operative infection; severe COPD greatly increases the chance of respiratory failure and the need of ventilator assistance; co-existing cancer and/or immune deficiency can significantly complicate care; anticoagulant use and significant coronary artery disease can bring significant issues. In any of the above circumstances you would be foolish to travel without discussing it first with your caregivers. I certainly do not intend to dissuade anyone from traveling for care, but it is important to consider all angles before embarking on a journey outside your home area without some serious thought. Nonetheless, many thousands have gone before, and the majority would go again!

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