Medical Tourism and the Risks of Air Travel – Airtravel during Pregnancy
In this part VI of the “medical tourism and the risk of air travel” – series, I want to touch on flying when pregnant.
If you have not read the other post, you may want to do so by clicking here.
Traveling by plane when pregnant is probably the most comfortable way to journey and it has been shown that the changes in oxygen pressure during the flight have little effect on the fetus. In fact, some airlines allow airline staff to continue to work on board of a plane up to 6 months of pregnancy.
However, there are some things to keep in mind:
For increased comfort, it is recommended that pregnant women abstain from gas producing foods at minimum one day before the flight. It is already crowded in your abdomen. All you need now is being bloated during a flight.
If you often feel nauseous during the early phase of your pregnancy, this may increase during a flight. Talk to your doctor if medication that reduces the feeling of nausea might be right for you.
One thing to definitely avoid is any trauma to the abdomen during the flight. Thus, it is recommended that pregnant passengers wear their seat belts all the time when seated as “… turbulent air can occur suddenly and unexpectedly.” If you have travelled by air as much as I have, you will know that such turbulent air can indeed be rough and cause injury if you are not in your seat with your seat belt fastened.
Afore mentioned is a bit of a chicken and egg situation, though. On the one hand, during late pregnancy you suffer from compression of your bowel and your abdominal blood vessels due to the large uterus, possibly resulting in swelling of the legs, deep vein thrombosis or thrombophlebitis, which would suggest that moving about the aircraft every hour or so is a good thing to do. On the other hand, you want to avoid injury due to turbulent air that surprises you during your stroll in the cabin. I suggest you be extra careful when you move about, hold on to the back of the seats, and return to your seat at any sign of turbulent air. It is also a good idea to request an aisle seat, so getting up becomes easy and you don’t have to climb over your fellow passengers as much.
If you have suffered from venous thrombo-embolism in the past or are prone to venous thrombosis you need to discuss your flight plans with your local primary care physician. He or she may decide to put you on short term anti-coagulants.
If your blood has a reduced capacity to carry oxygen due to e.g. anemia, it is again advisable to discuss your travel plan with your physician at home.
Finally, if you are pregnant in week 36, you should check with your airline if they will allow you to fly, particularly if it is a long distance flight. You also check that your destination does not represent a health hazard to your baby, should you be forced to give birth away from home. But if you travel in week 36, it may just be you desire to deliver your baby in another country which is something many women do.
With that said: safe travels.
This is part five of my blog series on air medical tourism and the risks associated with air travel.
You may want to go back and read parts I – IV, also.
Originally, I wanted to break this subject down into three parts, however, the more research I did on the subject, the more I realized that I would not fit all into three posts, particularly with my self-imposed 500 word per post limit (which I struggle to adhere to).
Today’s post will deal mainly with pulmonary diseases and their impact on patients’ well being during a flight.
As a general rule, any patients with pulmonary diseases such as asthma, chronic obstructive pulmonary disease, bronchiectasis and cystic fibrosis, interstitial lung disease, lung cancer, neuromuscular disease effecting the lungs, pulmonary infections, pneumothorax, pleural effusion, or pulmonary vascular conditions should receive clearance for flight by a medical doctor, prior to boarding an aircraft.
The physician will try to establish how much the pulmonary disease affects the patient during the flight, if the provision of oxygen during the flight is sufficient to remedy the symptoms, based on the predicted altitude and the duration of the flight. Lung function tests and blood gas analysis are main parameters during such examination.
A single and very practical test is to see if the patient can walk for about 50 meters or climb a flight of stairs at normal speed, without becoming significantly short breathed.
Patients that cannot pass this test, and are still cleared for flight, should consider booking a wheelchair or electronic cart service at the airport and avoid smoking areas (in those few airports where the still exist), also, plan enough time between connection flights, so you arrive a the gate relatively relaxed.
Here are some common pulmonary diseases and precautions for air travel (I cannot cover all, so if in doubt, contact your medical doctor, which you should do anyway):
Bronchial Asthma: if your asthma is unstable, sever, and has caused recent hospitalization, air travel may be contraindicated. For asthma patients that are cleared for flight it is vital that they carry their asthma medication on board and store it somewhere easy to reach (which in most cases is not the overhead bin).
Chronic obstructive pulmonary disease: if cleared for flight by a medical doctor, in flight oxygen may be required. It is important to point out, that you cannot bring your own oxygen tank on board. Therefore, it is necessary that you contact the airline before, in order to find out if they provide oxygen, and if they do, to ensure that it is available during your flight.
Bronchiectasis and cystic fibrosis: require good infection prevention measures, hydration, effective cough and medical oxygen therapy during the flight. Here it may be necessary that your doctor contacts the airline’s medical department in order to plan personal requirements during the flight.
Pulmonary infections: Patients with active and contagious infections (e.g. Pneumonia, Tuberculosis) may not travel by plane.
Pneumothorax: a pneumothorax or pneumomediastinum must be corrected before flight.
Pleural effusion: must be drained and corrected at least 14 days before flight. An X-ray of the thorax prior to flight needs to confirm that there is no accumulation of new fluid.
Pulmonary vascular disease: Patients with pre-existing pulmonary embolism and pulmonary hypertension may suffer from a worsening of the hypertension and reduced cardiac output. Anticoagulation of the blood, medical oxygen, and restricted exercise may help reduce risks. A medical doctor must evaluate your fit for flight status before boarding a flight.
As you can see, pulmonary conditions and air travel is a tricky combination. It is highly recommended that you seek advice of a physician experienced with both as he/she will review your individual case and make recommendations suitable for your particular conditions.
If you are planning a medical trip and are unsure about your lung condition, discuss your case with a medical travel facilitator. They should be able to point you into the right direction in terms of which doctor should pre-evaluate your condition.
This is part four of my blog series on air medical tourism and the risks associated with air travel.
You may want to go back and read parts I – III, also.
The main topic of this post will be Deep Vein Thrombosis (DVT) and the risk of pulmonary embolism.
DVT describes the formation of a blood clot in deep veins, usually those of the legs. While this condition in itself is not dangerous, the loosening of that clot and the resulting transportation to the lung vessels can lead to severe complications, even death. It seems to be common knowledge that air travel, particularly in economy class, leads to an increased risk of suffering from DVT because of the limited space available for each passenger and the reduced mobility during a long haul flight. There seems to be a perception that those travelling in business or first class are not at risk of suffering from DVT. The term “economy class syndrome” seems to further support this idea.
It may be surprising, but there seems to be no scientifically relevant or otherwise significant study establishing that deep vein thrombosis and air travel are indeed related. What is known, however, is that 20% of the population may have some type of increased blood clotting tendency.
But it remains unknown if DVT that occurs during air travel is the result of prolonged immobility in an individual with increased risk factors or whether there is a causal relationship with the airplane environment.
So does that mean I should not worry about DVT during air travel? This would be the wrong conclusion. While there are no conclusive studies showing the relationship between DVT and air travel we can still provide reasonable recommendation that are based on the results of studies in other environments.
So what are these recommendations when it comes to DVT prophylaxis during air travel?
Again we need to segment the passenger into groups:
- the passenger without increased risk of DVT
- the passenger with increased risk of DVT.
Rudolf Virchow, a German doctor who lived from 1821 – 1902 described factors that increase the likelihood of DVT (aka the Virchow Triad) as:
- Reduction of blood flow
- Changes of blood viscosity
- Damages or abnormalities of the vessel walls and venous valves
Since this means not a lot to most of us, here is a list of risk factors that we can relate to much better:
- Blood disorders that effect the bloods clotting tendency
- Cardiovascular disease
- Current or history of cancer
- Recent surgery
- Recent stroke
- Recent trauma to the lower extremities of the abdomen
- Personal or family history of DVT
- Pregnancy
- Estrogen hormone therapy (including use of oral contraceptives)
- Age above 40 years
- Prolonged immobilization
- Dehydration
- Smokers
- Obesity
- Varicose veins
- Alcohol abuse
So what can you do to reduce the risks of DVT?
If you are a passenger with no risk factors consider frequent stretching exercises, particularly of the legs and to walk about the cabin as well as change your seat position. Recommendations of what exercises to do can be found in the in-flight magazine in the famous “seat-pocket in front of you”.
One caveat to consider is that if you walk about the cabin and the airplane hits turbulent air, there may be an increased risk of secondary injury from you not being in your seat. That risk has not been studies either.
DVT risk passengers can be further categorized into those with:
- Low risk: obesity, active inflammatory processes, minor surgery within the last 3 days
- Moderate risk: cardiovascular conditions, hormone therapy, pregnancy, recent delivery, paralysis of the lower limbs, recent trauma to the legs.
- High risk recent: pulmonary embolism, know blood clotting disorders, recent major surgery (within the last 6 weeks), recent strokes, cancer, family history of pulmonary embolism
Low risk patients are recommended to stay well hydrated during the flight and wear special anti-thrombosis stockings as well as conduct stretching exercises.
Moderate risk patients should really contact their physician who will most likely recommend the above plus low does aspirin
High risk passengers will additionally receive low molecular weight heparin instead of aspirin.
A special category form those patients who already are on long term blood thinners due to a previous heart condition and who are travelling to have surgery at their destination.
The surgery requires that they stop taking the blood thinners in order to decrease intra-operative bleeding.
These patients must seek the consultation of a medical doctor who will most likely switch to low molecular weight heparin as well.
797 words. I need to stop here.
Next post will focus on lung diseases.
Until then.
This is part three of our blog on the subject of medical tourism and the risks of air travel.
If you have not read the other posts, you may choose to do so.
Having established the need to plan air travel in medical tourism in part one, the effects of air travel in general in part two, I would now like to focus on the effects of air travel on the passenger with a pre-existing medical condition.
As a general guideline, I would like to establish the following: If you have a medical condition for which you are travelling by air to receive treatment, ask your doctor or medical travel consultant for advice if air travel is suitable given your condition.
If they are unable to answer this question, you may want to look for a different treatment provider.
Also, contact (or have the travel consultant contact) the airline to determine if they have any special regulations with regards to your condition. These are standard procedures and any good medical travel facilitator should know how to manage such requirements. If they don’t know what to do, please choose someone else.
If your medical condition is unstable, you may not be able to fly, or flying may require special precautions that need to be implemented by the airline. If you suffer from infectious diseases that can be transmitted to other passengers, your air travel requires additional planning or should be postponed altogether. If your mobility is impaired you may require a wheelchair service and if you need regular oxygen supply during the trip, it needs to be pre-arranged as most airlines do not allow you to bring on board your own oxygen tank.
Larger airlines offer transportation on stretchers as well as in specially designed medical in-flight compartments. Some airlines even offer escorts by a medical doctor. However, all this needs to be planned properly in advance and you need to choose a medical travel facilitator and airline that is experienced enough to manage such procedures.
Let’s discuss some common medical conditions and how they will be affected during air travel.
Cardiovascular disease:
Patients suffering from cardiovascular disease planning to fly required special attention. As outlined in part two, air cabin pressure on a flight is lowered which directly results in a reduced oxygenation of the blood. This is compensated by an increase of ventilation, taking deeper breaths, and by an increase of the heart rate. Oxygen supplementation may be required to manage the situation.
Patients with episodes of angina pectoris should always carry their medication with them. Unstable angina patients should fly only under medical supervision.
Patients who have recently suffered from an uncomplicated myocardial infarction, should wait 2-3 weeks before flying or until they are back to normal activity levels.
Patients suffering from decompensated congestive heart failure may require medical supervision during a flight.
Patients with symptomatic heart valve disease should be evaluated by a cardiologist before boarding a flight. If there already is a reduced oxygen saturation of the blood due to the valve disease, therapeutic oxygen may be required during the flight.
Patients suffering from high blood pressure should have no problems flying, as long as their blood pressure is well controlled. These patients should carry their prescribed medication with them during the flight.
Patients with implanted pacemakers and implanted defibrillators are often in doubt if their pacemaker will be affected by security equipment or will have an impact on airplane electronics. This concern is unfounded, however, if in doubt, contact the manufacturer of the implanted device. Again, a good medical travel facilitator should be able to assist you how to contact the manufacturer.
Here is a list of recommendations for passengers with cardio-vascular disease:
- Bring your cardiac medication on board. Ensure sufficient quantities. Have them in a plastic bag, easy to reach (not in the overhead bin)
- Have a list of medication with you in a separate place, in case you lose your medication
- Have a copy of your most recent ECG with you
- If you have a pacemaker, bring the manufacturers identification card
- Book an aisle seat, near the front and close to a toilet
- Assure that your transportation within the terminal is secured.
- Reduce stresses through walking long distances by arranging for wheelchairs or cart transportation.
- Book flights with adequate connection time in-between so you are not rushed.
- If you require oxygen, contact the airline in advance. You may not be able to bring your own oxygen on board.
Here I am typing away and I have already exceeded my self-imposed limit of 500 words per post. So I need to stop here.
Next week we will cover: Deep vein thrombosis, pulmonary disease, pregnancy and air travel, ear nose and throat conditions, surgical conditions, psychiatric conditions, and others.
Somehow, I have the feeling this Medical Air Travel Blog will turn out to be much longer than expected.
Well, hang in there, it is important.
Please visit the blog again next week.
When determining health risks related to air travel we can categorize passengers into three main groups:
Passengers with no medical condition
Passengers with a medical condition on their way to treatment
Passengers with a medical condition who have received treatment
Passengers with no medical condition
You may be surprised to find this category at all. You may think: “I am healthy; there is no problem that I take a flight to my far away holiday destination.”
Indeed, our modern commercial airliners are very safe and even somewhat comfortable (unless you are like me and consider economy class travel a violation of basic human rights).
However, travelling by plane imposes several stresses on passengers.
Pre-flight stress:
Ever been late for a flight? Were you ever standing in a long security line while your name is already called for the second time? Were you ever running down the long hallways of a large international airport terminal, slowed down by other passengers who seem to suddenly have all time in the world? Then you know what I mean with pre-flight stresses.
In-flight stress:
So you just made it. You are the last to board the aircraft, you crash into your seat breathing heavily and you fumble with the air vent in the overhead panel, because is it hot in this plane. You are drenched in sweat due to your recent terminal-a-thon, that the aircraft has been parked in the sun, and the pilots seem to want to save electricity (as if they had to pay for it out of their own pocket) and did not turn on the onboard air-conditioning. You are beginning to dehydrate. After take-off the air is dry (10-20% humidity), further adding to your dehydration. “You don’t drink enough, because there was no time buy some water before boarding and the water supply on board seems to be limited (at least the flight attendants seem to serve only a few half full cups of water every few hours).
The cabin pressure is not the same as at sea level (despite common believe). Most airplane cabins are pressurized to an altitude pressure of 5000 to 8000 feet (or 1525 to 2438 m). This lower pressure results in a lower blood oxygenation. While this is not a problem for most healthy patients, it is one reason why you might not get a good sleep on a flight.
Unless you are lucky to travel business or first class, you will be cramped into small seats with little leg room. This is not only uncomfortable, it leads to reduced opportunity to stretch out or walk about the cabin (tip: on flights longer than two hours: always request an aisle seat, so you can get up and stretch without disturbing your seat neighbour)
Sitting for a longer period is tolerated by most healthy patients, however in can increase swelling of the legs, cramps, and circulatory problems. DVT (deep vein thrombosis) and the potential for pulmonary embolism are concerns even for healthy passengers.
Turbulent air that rocks and shakes the plane (usually the strongest the minute you have received your meal) can make you feel apprehensive or cause nausea.
Post-flight stress:
The main post-flight stress is jet lack (aka circadian desynchronosis) the de-synchronization of the body’s internal clock which can lead to sleeplessness and tiredness.
Most healthy passengers deal with these stresses and they are simply considered inconveniences and the price to pay for travelling by plane. However, for the passenger with a pre-existing medical condition or passengers who have just undergone surgery, the above mentioned conditions can be potentially hazardous, or make it impossible to fly all together!
In the next post, I will discuss the various conditions and provide suggestions how to make the flight safer.
Please subscribe to this blog or check for updates in a few days.
Lufthansa Flight 506 from Frankfurt to Sao Paulo, Brazil:
I squeeze myself into the too tight economy class seat.
I was lucky to get an emergency exit seat on this otherwise completely overbooked flight.
Even with the extra leg room that comes with this seat, I still think that flying economy must somehow violate basic human rights. The space available in these seats is simply too cramped and unacceptably tight.
However, I am somewhat relieved that I do not have to sit in the even tighter middle seat of the middle row of this slightly aged Boeing 747-400.
There is some commotion as people board and place their luggage into the overhead bin, under the seat in front of them, or fight with the fact that the hand luggage is really too large for either.
A few rows behind me I hear a woman ask a flight attendant:
“Can I have that emergency seat over there, if it stays empty? I have two freshly operated knees and need be able to stretch my legs.”
“It will not stay empty, the flight is completely booked…”, was the flight attendant’s simple reply.
“… and even if it did, you would not be assigned to an emergency exit seat, as your two freshly operated knees may be a handicap to operate the exit in case of an emergency,” …I think to myself and complete what the flight attendant did not want to say at this point.
I hear another passenger behind me: He asks to be seated into an aisle seat because of a freshly operated foot that he would like to stretch into the aisle, once the on-board service has finished.
As more passengers board, occasionally slowed down by crutches, loaded with too much hand luggage and duty free shopping bags, I sit in my seat asking myself:
Medical travel is obviously everywhere…Here, and on this flight, we have a several passengers who traveled for medical treatment in Germany and it becomes apparent that these passengers have not planned their medical trip adequately.
You are on a 12,5 hour flight to Brazil
… in economy class…
You just had surgery and you are asking to change your seat after you have boarded the plane…?
It does not work this way!
You have probably spent a lot of money on your medical journey. You focused on how to get to your medical destination. However, and most likely, you did not spent much time on planning how to get back home.
The risks associated with your return flight are high and may just jeopardize the results of your medical treatment abroad.
Your return flight needs to be adequately planned. Failure to do this can have a significant impact on your overall treatment results.
Most people talk about the risk of DVT (Deep Vein Thrombosis, a potentially lethal formation of blood clots in your deep veins of your lower leg) and how to avoid it. However, DVT is not the only complication. There are others that depend highly on what medical treatment you have received.
This three part blog will focus on this very subject.
Your medical records – your responsibility!
You may have heard that you have a right to get copies of your medical records. It is more than just a right: It is also a responsibility!
It is your job to obtain copies of your medical records as part of your personal healthcare management process. The same can be said about the medical records of your children.
Particularly if you are considering a medical trip to another country, complete medical files are of key importance.
The first requirement a doctor or healthcare consultant abroad will confront you with is to send copies of your relevant medical files. Those dedicated to the delivery of quality healthcare will ask this question even before answering your inquiry about a quote for treatment!
There is often significant confusion on behalf of the patient what medical files to send. Here, a patient might require some guidance.
Ask yourself the following questions:
- Am I looking for treatment?
- Or am I looking for diagnostics in order to determine what is wrong with me?
If you are looking for treatment, you will need to prepare your medical files and send them to the specialist who is expected to provide treatment. At the outset of provision of treatment is knowing what needs to be treated. In other words: a medical diagnosis is required.
A fundamental medical principle is that: “Without a diagnosis, there cannot be any treatment”. The doctor would not know what to treat.
Despite a growing number of patients well educated about their medical conditions, establishing a diagnosis should really be left to a professional medical doctor. Unless you have a medical background, self-diagnosis is almost never a good idea. Before a diagnosis can be established, a diagnostic work up is required.
You can find a diagnosis on your doctor’s referral letter. If such referral letter does not exist, ask for it. It is only good medical practice to write a medical referral letter to ensure the medical care continuum is maintained. The referral letter should be free or only cost you a small service fee. Essentially, you have already paid for it, when you paid your medical bill for the visit to the physician.
The referral letter most commonly includes:
- Your personal data, such as name, gender, date of birth, etc.
- Reason of your visit to the doctor
- Conducted medical tests
- Diagnosis
- Treatment provided
- Type of consultation the patient received
- Further treatment recommended
It should be dated, signed, and (very important) typed/printed and not hand written.
This letter is a good basis for the doctor who will continue the treatment to start developing a treatment plan (including the calculation of potential costs of such treatment).
Additional files might be requested, such as lab works, medical imaging, EKGs etc., but the referral letter should always be the first step.
You should always request all medical records to be delivered to you as a digital file. The days of hard copies are over (no matter what the seasoned Professor will tell you). A hard copy is for your information only. What you need are digital files. Ask for your medical files to be delivered to you digitally.
Digital files make it easy for you to store your medical records on your computer or on services such as (www.google.com/health) or Microsoft’s HealthVault (www.healthvault.com). Medical files stored in such manner are easy to send to other healthcare providers either via email or by sending a web link.
International Healthcare providers often provide upload sections on their web page.
Any ethical medical service provider will not offer treatment without knowing a diagnosis. If the diagnosis is unknown, the first objective is to establish one. In other words: diagnostic tests are required.
This is what you need to do when you are unsure about what is wrong with you or what treatment is required.
Of course, a diagnosis can be established when visiting your treatment center abroad. There is one caveat, though: When you travel long distances without a proper diagnosis you may run the risk that after diagnostics are completed a treatment different from what you had expected is suggested. It is also very difficult, if not impossible, to provider a cost estimate without a diagnosis and related medical files. This means that when you travel abroad for treatment without previously providing your medical files containing a diagnosis, a certain element of uncertainty remains.
An experienced international medical travel consultant will be able to guide you through this process.
There are other reasons, why it is a good idea to keep your medical records up to date, including:
- It makes it easy for your doctor to collect an accurate medical history
- It shows how your health changes over time. It helps the doctor to compare your health at different time points and identify any changes in your health
- It shows the early stages of a chronic disease and how it’s progressing or responds to treatment
- It allows you to verify charges and identify any errors.
Managing your health records is your responsibility; if you are diligent it will make it easier for a relevant specialist anywhere in the worlds to provide you with adequate treatment. Without your medical files, it will be challenging, if not impossible, to plan a medical trip and subsequent treatment.
In our practice we see patients travelling abroad for medical treatment for a number of reasons. Most commonly these are:
- Elective aesthetic, such as dental or plastic surgery
- A real medical need requiring treatment (elective and emergency)
- Patients who could not be helped adequately at home (either due to the illness being chronic, incurable, or even terminal.
We have a fair share of patients that fall into the last category. These patients pose particular challenges for a medical travel consultant due to the following reasons:
- They have expectations for a cure that in most cases cannot be met
- Their families may “drag” them to treatment, even though the patient may not want this.
- If a treatment is indeed possible, it will most likely be a lengthy process and not a matter of flying to the treatment center, receiving treatment, and returning home a week later.
These cases, much more than any other in medical travel, require the close communication of all involved parties, in particular between doctor in the treating center, and the doctor who will continue the treatment at home (as outlined in my blog on physician to physician communication)
Why is this so important?
Let us take a cancer patient as an example: A patient is diagnosed with a malignant type of cancer that requires urgent surgical removal, followed by several courses of chemo-therapy.
Medical travel is possible in this case, and it may make sense to travel to a super specialized oncology center. There, the surgery can be performed. However, what about the chemotherapy? Chemotherapy is usually a process that happens over several weeks and months. In an ideal world, the patient would stay near the oncology center and go through all chemotherapy cycles under the supervision of the specialist oncologist.
Unfortunately, most patients cannot afford such a lengthy stay abroad and want to travel home after surgery. This means the chemo-therapy must be started at home. While this is possible, it requires that the patient is compliant with the requirements and a medical doctor is available at home who can implement the chemo-therapy based on the recommendation of the expert oncologist.
Good medical travel planning is required in these cases.
It will be more complex, if the cancer has already advanced to a point, where it is not treatable anymore. These are not good cases for medical travel. However, in some instances, it may make sense to get a second opinion by an oncology expert, particularly with regards to the treatment recommendations and procedures. In these cases, the treatment focuses on extending and improving quality of life.
If the patient’s medical files are complete, travel may not even be required. If they are incomplete, travel for a diagnostic work up is mandatory.
The same applies for chronic illness, as this too, requires long time management which does not make it ideal for medical travel.
In all of the above cases good medical travel planning and follow up care is required for such a trip to be successful.
Learn more about cancer treatment in Germany
There is not a single day that goes by during which we don’t receive an email containing the line:
“I am looking for the best Doctor in Germany.” (our company manages inbound medical travel to Germany)
It is all too understandable why we are looking for the best doctor. After all, health is one of our most valuable assets.
However, there are several fundamental issues with the search for “The Best”
For one: How does one measure what is truly “The best”. Secondly: is what is the best for one, really the best for the other?
The first question (how do you measure what really is the best) already opens Pandora’s Box of possible answers:
Are we talking about the best surgical skills, the best diagnostic skills, graduation from a high profile medical school, the best treatment results, the smallest number of malpractice cases, the largest amount of published studies… the list goes on…
What defines “The Best?”
Purely from a language and grammar point of view, the best implies that someone or something is better than all of the rest. By definition of the word, there can only be one (doctor) who is the best.
How does one go about measuring who is the best doctor? To my knowledge, there is no institution or government body, who measures the quality of a doctor using validated procedures to evaluate and ensure quality (if I am mistaken, I am happy to be informed otherwise).
Essentially, a patient is on his/her own, when trying to find “the best doctor”.
Most of us don’t have the required background and knowledge how to evaluate the quality of work a medical doctor delivers. So we turn to so called proxies, or replacement measures, that should help us evaluate who the best doctor is. Searching the web on this subject you will find recommendations like: is the receptionist friendly, is the exam room clean, does the doctor look well groomed, does he/she have good bedside manners, is he friendly, does she take the time to answer questions?
Is this a list of qualities that make a good doctor… that make the best doctor?
As an example: We have a surgeon in our network who is perceived as arrogant and unfriendly by many of our patients, but his surgical results are far above average when compared to the results of others (yes, we do have that data). If I would require the type of surgery he performs, he would be my number one choice; and still, this does not make him the best doctor, in fact, due to his demeanor, he is often considered the opposite by our patients: a bad doctor.
Fact is: there are no best doctors – not in America, not in Germany, the UK, India or anywhere else in the world no matter what billboards, web pages, and glossy in-flight magazine adverts tell you.
There are however very many good ones. What makes a good doctor depends highly on the patient’s needs and expectations. This is different for everyone.
When my patients ask me for the best doctor, I usually ask them: what exactly are your needs? What are your expectations? The aim is to find a doctor that is right for the patient’s requirements.
Doing this can lead to a doctor/patient match that is so ideal the patient may just walk away feeling satisfied in having met the Best Doctor, after all.
Visit us to learn more about medical treatment in Germany
The days that the family general practitioner decided which medical treatment is ideal for a patient and which specialist the patient will be referred to, are long gone.
Today, patients increasingly make their own decision based on what they perceive is best for them. They will then venture onto a quest trying to find the right physician who will provide them with their desired treatment.
This growing trend can be observed particularly in the medical travel industry.
Again, not a day goes by, that I don’t receive a patient’s request asking for a treatment that might not be ideal for him or her. Yet, due to their internet research, the patients are convinced that their choice is the right one.
A difficult situation… if it is obvious that the treatment the patient seeks is not ideal, it is the only right thing to inform the patient accordingly. On the other hand, it is often difficult to change a patient’s opinion. An opinion which they have developed through their own research. There is a high risk if the attempt is made to change the patient’s mind, that the patient will go elsewhere, until the patient finds what he or she is looking for.
We have struggled with this dilemma for some time, however, we now have made the decision that we will not offer any treatment to a patient, that our doctors believe is not right for them. The rational is simple; a treatment has a higher success rate when it is used for the right indication. Wrong indication and the success rate drops dramatically and with that the rate of unsatisfied patient increases.
Who wants unsatisfied patients?
Thus, and in order to ensure that the patient receives the correct treatment adequate pre-screening is required. Anyone involved in pre-screening a medical tourist should consider it his or her responsibility to adequately preview the patient’s medical file and point the patient towards the appropriate medical doctor.
However, often it is not clear what type of treatment a patient really requires. In these cases, and in order to prevent disappointed patients due to a change of plan when they arrive at the treating center, it may be advisable to establish communication between the doctor in the patient’s home country and the treating physician in the destination country.
Not only does this approach ensure that the medical history and relevant medical data is communicated quickly and professionally between the two experts, it also ensures that the physician at home (the one the patient is most likely going to see after treatment abroad) is aware of the course of treatment from the beginning. The underlying rational for this philosophy is that medical travel does not end when the patient boards the plane to fly home; it ends when the patient has fully recovered.
An example: A patient from the UK travels for bariatric surgery in Germany and receives a gastric sleeve operation. Surgery and initial recovery period go well. Before return home, the patient receives dietary guidelines for the first few weeks, instructions to visit the GP immediately upon return home, what blood test to undergo and at what time, etc. However, the patient is not compliant, does not adhere to the dietary instructions, the GP is unaware of the patient’s medical trip. He discovers a vitamin B12 deficiency some 12 months after the obesity surgery in Germany by accident.
In an ideal world the GP would have been involved in the medical trip already before departure, would have been informed about the medical institution the patient is travelling to, the surgeon performing the procedure, the follow up requirements and contact details of the bariatric surgeon back in Germany, in case of any questions. This is simple and straight forward and yet, in many cases it simply does not happen.
Why does this communication not take place? Most likely because no one actively initiates and drives such communication. The patient doesn’t because he or she might not see the necessity, the GP doesn’t because they might be unaware of the medical travel, and the surgeon abroad doesn’t because he may also be unaware of the need. The German doctor will write a discharge letter in German which concludes their part of the treatment.
A third party might be required to drive and motivate this communication to occur.
This task falls into the area of responsibilities of a good medical travel consultant who should establish communication links between the treating doctor abroad and the follow up physician at home so that the recovery can occur as part of a controlled process rather than being left to chance. In addition, the communication should not rely on highly sophisticated technologies or computer software, but on those technologies that both patient and physician can use with ease and sufficient expertise. Finally, all this needs to be done while maintaining relevant patient data protection regulations.
Other responsibility of a medical travel consultant include assisting the selection of the appropriate specialist, facilitating appointments and treatment schedules, collecting relevant medical data, reviewing the case together with the specialists, managing the actual trip, communicating with family members, and planning the follow up process at home of which communication between the care providers is of high importance.
Only through this holistic approach to medical travel, can medical travel be a safe alternative for treatment at home, should treatment at home not be an option.
With medical travel on the rise, general practitioners will have to be prepared to “deal” with the returning patient. In order to do this, information and communication is required. Both patients and follow up physicians may benefit if a third party who is involved in (and oversees) the entire medical trip drives relevant communication between international healthcare providers. Such increased communication will make medical travel a safe option for the patient, provide GPs with new and high quality alternatives for patient referrals and make the follow up back at home adequate for the treatment the patient has received abroad.
Finally, the local health insurances benefit from such improved communication. It should reduce the risks of patients returning from a “wild medical journey” and developing complications back at home? Such complications may lead to expensive and urgent emergency treatment.
Learn more about medical treatment in Germany
