Wednesday, June 29, 2005

The Rise of "Medical Tourism"

Here's an excellent article by Jon Herring on medical tourism.
It summarises the pros and cons of medical tourism extremely well, since it's based on his personal experience. I just wish they wouldn't call it "tourism". These are patients seeking medical care. When Indians went to Mayo Clinic in the past for their medical treatment, were they called tourists ?


My trip to Central America is just one example of what has become known as "medical tourism." For a variety of reasons, people from around the world are traveling to other countries to obtain dental, medical, and surgical treatment ... while also enjoying a vacation.

Because this is a relatively recent development, there are few reliable statistics regarding this niche industry. But in an article two years ago, India's BusinessWorld Magazine provided numbers suggesting that millions of travelers spend more than $40 billion a year on combined medical and travel expenses.

Four countries in Asia - Thailand, Malaysia, Singapore, and India - attract well over a million medical travelers each year, and these numbers are growing rapidly. In most cases, patients are traveling from the developed countries of the United States, Canada, Great Britain, Australia, and the Middle East to less-developed countries.

Why would someone travel for healthcare?

For two decades, the standards of healthcare have rapidly improved in a growing number of "third-world" countries that now offer world-class medical services that meet the high standards of the U.S. and Europe. These countries boast a variety of modern hospitals and state-of-the-art outpatient facilities with newer technology and better equipment than many of those in the states. In many cases, the doctors and specialists in these facilities were trained in the top medical and dental schools in the U.S.

When you consider the affordability of international travel, favorable exchange rates, and high-quality care at a fraction of the cost, it's easy to see why medical tourism is booming. But these are not the only reasons people are traveling for healthcare.

Surging demand for healthcare in the developed world is exposing the flaws in our system.

In Canada and the UK, for example, patients who wish to receive treatment under the government's socialized healthcare plan are required, in many cases, to wait several YEARS to receive the treatment they need TODAY. And the U.S. medical system is a massive paper-pushing bureaucracy, plagued by fraud, inefficiency, and waste. Combine this with outrageous malpractice insurance fees, and the cost of healthcare in this country has risen to the point of being ridiculous.

What about the service?

Doctors, dentists, and hospitals that cater to medical travelers actually have to meet a higher standard of service than those in our home country. That's because many of these facilities and practitioners get their business via word-of-mouth referrals. And unless you have a high-quality experience, you are unlikely to spread the word.

Options exist for full-service travel arrangements, private chefs, dedicated staff, and a number of tailor-made services. In addition, the staff goes out of its way to make you feel comfortable and right at home. And an appointment with a specialist, diagnostic testing, and follow-up can completed within hours. In the U.S., that would usually require several appointments and hours upon hours in waiting rooms.

All of these factors play a role. But the primary factor driving the growth of medical tourism is the cost savings. Procedures start at around 10% of the cost of the same procedures here in the states. In some cases, the cost might approach half of what you would pay here. But in almost all cases, a significant savings can be achieved, justifying not only the cost of travel, but also lodging, meals, and entertainment while in the host country.

Medical tourism began primarily with elective and cosmetic procedures that are not covered under insurance - and many people still travel for this reason. Today, though, growing numbers are traveling for life-saving and medically necessary procedures, such as joint replacements, cataract surgery, bone marrow transplants, and even bypass surgery.

To have a total hip replacement surgery in the United States would cost $40,000+. The same surgery in India or the Philippines would cost less than $8,000.

In the Unites States, heart surgery averages $50,000+. The same operation with comparable rates of success and complications costs only $10,000 in Bombay's top hospital.

A $250,000 bone marrow transplant can be obtained for around $25,000 in India.
India is emerging as the leader in the medical tourist industry, especially when it comes to complex surgical procedures. But throughout Southeast Asia, modern hospitals are springing up near tourist destinations to service this growing market.

Large numbers of people are also traveling to Central and South America, which offer high-quality, affordable healthcare and the chance to convalesce in the tropical air and healing sunlight.

What are the downsides?

You can get some of the best healthcare in the world here in the United States - and some of the worst. The same can be true in other countries as well. Under certain circumstances, there can be many advantages to traveling for healthcare. But there are some obvious downsides to consider. For example:

Your insurance policy may not cover treatment - and even if it does, you will probably have to pay first and wait for reimbursement.

All surgeries and medical procedures carry a certain level of risk, no matter where they are performed. The same risk of complications exists overseas as it does here.

There is little opportunity for follow-up care. So it might be a good idea to give yourself a few extra "cushion" days after your last appointment and before you plan to leave the country.

Part of the savings you achieve in a foreign country is because they are not strapped by the same malpractice litigation we see in the states. This could also mean that you have little legal recourse should something go wrong.

Remember the "tourism" angle to all of this. If you receive great medical care and get mugged while out shopping, it might not make for a great trip. As always, be careful while traveling.
I hope I've opened your eyes to the many possibilities that exist for elective and medically necessary healthcare and dental work that you might not have known about. This is a rapidly expanding aspect of modern healthcare, so you are sure to hear more and more about it.

As always, my best advice to you is to focus on “health care” so you don’t need “medical care”. But if you find yourself or a loved one in a position where a medical or dental procedure is needed, now you know that you have options.

Friday, June 24, 2005

The stress of being an IVF specialist

Being infertile can be stressful – and so can being an infertility specialist ! The infertile patients who get pregnant move on to their obstetrician and then their pediatrician – but the ones who don’t get pregnant come back again with loads of questions !

Patients need a shoulder to cry on, and I am happy to provide this, but often there are so many questions , and very few answers.

Why did the cycle fail ?
What do I do next ?
How many embryos should I transfer ?
Should I do another cycle or should I adopt ?

Unfortunately, we can only explain about one-third of things ; one-third is educated guessing; and about one third we have no idea and can't explain why it happened.
It's not much fun not having the answers, but this can be a humbling experience !
This is why it's much easier dealing with educated patients, who have realistic expectations of what we can do - and what we can't !

Thursday, June 23, 2005

Common Good: Defensive Medicine Widespread, with Serious Consequences

Common Good: Defensive Medicine Widespread, with Serious Consequences: "Defensive medicine is 'a deviation from sound medical practice that is induced primarily by a threat of malpractice suits.' Forty-three percent of physicians said their most recent defensive act was 'using imaging technology in clinically unnecessary circumstances.'"
You should be aware why your doctor may over-test and over-treat you.

Wednesday, June 22, 2005

Behind the Medical Headlines

Behind the Medical Headlines: "Welcome to Behind the Medical Headlines, which has been developed to provide authoritative and independent expert commentaries on topical medical matters reported in the international media." Doctors are now trying their best to demystify medicine so patients can make more sense of it.

"Expert patient"--dream or nightmare?

"Expert patient"--dream or nightmare? : An interesting and frank perspective on why doctors sometimes feel threatened by the "expert patient". I heartily agree with the conclusion - "Doctors need to act on what they already know—that all patients are experts, however uninformed or misinformed they may be about health issues. Patients' expertise is valuable because by understanding the patient's views and situation, the doctor is better equipped to identify a solution that will lead to a successful outcome, however defined."

But I did everything my doctor told me too !

As an infertility specialist, I see lots of patients who have been poorly treated by other doctors. When I ask them why the quality of their care was so poor, they often look confused and distressed. " But I did everything my doctor told me too !"
I wish this were enough to ensure you were getting good medical care. Unfortuntely, the truth is that if you are lucky and you have a good doctor, this doctor will help you make the right decisions and get the best care possible. However, if you are unlucky, and don't have a good doctor, then what ? You jst cannot aford to leave everything upot the doctor. You need to trust him, but you also need to verify everything he says independently - there is too much at stake !

Consumer Health Webwatch

Consumer Health Webwatch This site rates the most popular consumer health websites, so you can separate the wheat from the chaff !

More people consult Google over health

More people consult Google over health " GOOGLE, the internet search engine, has now become one of the patient’s best friends, second only to the family doctor. " The times are changing ! And the nice thing about google is you'll always get an answer. Of course, making sense of the answer is another story...

Sunday, June 19, 2005

A simple tool to help you talk to your doctor - SAFE

When you visit your doctor, it's important that you have a clear agenda in mind, so you can communicate properly with him. I have found that SAFE, an acronym I devised , is very helpful.

SAFE stands for Story; Assessment; Fears; and Expectations.

S is your Story. This is what doctors call a medical history. You simply need to tell your story in your own words. The best way is to do this in chronologic order, starting with when you first started feeling unwell. It's a good idea to list all your symptomms, and if you write these down, it will help you ensure you don't forget anything important. Try to be as objective as possible - it's helpful to pretend you are a third party, reporting on the symptoms.
A is your Assessment of what you feel is wrong with you. I am not asking you to diagnose your own problem - just to let your doctor know what you feel is responsible for your problem. After all, you are the expert on your own body !
F is your Fears of what you are worried may happen to you as a result of your illness. Are you worried this will affect your ability to play tennis ? work ? affect your future fertility ?
E is your Expectations of what you want from your doctor. Do you want him to run some tests to reassure you that all is well ? Do you just want pain relief ? Do you want an accurate diagnosis ?

Here is an example of how an infertile patient could put the SAFE acronym into practise.
1. S = Story. Doctor, we've been married for the last 2 years. We used oral contraceptives for the last one year; and have been trying to have a baby for the last 1 year. Our sexual life is active; and my periods are regular.
2. A = Assessment. I really can't figure out why we aren't getting pregnant, because we are both in good health and everything seems to be fine.
3. F = Fears. I am afraid my tubes maybe blocked, because I did have a pelvic infection 2 years ago which was treated with antibiotics.
4. E = Expectations. I'd like you to run some tests on us to assure us we are normal and our fertility is fine.

Remember that your doctor cannot read your mind ! The more you tell him, the easier it is for him to help you. SAFE will help you do so !

Verbal First Aid

Verbal First Aid: "Verbal First Aid." What a clever word - it describes something so simple, and yet so powerful ! Not only is it important not to panic in an emergency, it's also important to make sure the victim does not panic. Here are some clever tools we all can use when confronted with an emergency !

HOPE - a spiritual acronym

I love acronyms - they make things so much easier to remember ! One I particularly like, because it is so simple, clever and useful is "HOPE".
All doctors agree that faith and spirituality play an important part in helping their patients get better. However, few know how to take a spiritual history. HOPE is a useful acronym, which can teach them how to do so.
H(ope): What are your sources of hope, meaning, comfort, strength, peace, love, and connection?
O(rganized religion): Do you consider yourself a part of organized religion?
P(ersonal spirituality and practices): Do you have personal spiritual beliefs that are independent of organized religion?
E(ffects on medical care and end-of-life issues): What effect has your current situation had on your spiritual practices?

Should I become a doctor ?

I am now a fairly "senior" physician, and lots of youngsters come to me asking for career advise. Since I am a successful doctor, they often ask, " Should I become a doctor ? " This is always a very difficult question to answer. While I am very happy with my career choice and the way my life has evolved, I also understand that a lot of what happened to me is because of luck and external circumstances, over which I had little control. Many of my peers are much more hard working than I am, but they are unhappy and discontented with the medical profession.
I also believe that everyone should make their own choices for themselves - after all, you need to live with the consequences of this decision. This is why I never tell people ( students or patients ! ) what to do - I just try to provide them with guidance so they can make their own decisions. I usually tell them that I am happy, but times are changing, and the practise of medicine is likely to be very different 10 years down the road. While good doctors will always do well, there may be much less autonomy and much more paperwork in the future !
The good news is there are many more options available today than there were a gneration ago. The best advise I can give is that they should explore all of these with an open mind; and to invest in a good book on Career Counselling , such as "What Colour is Your Parachute" by Richard Bolles.

The Joy of Medicine - finding meaning in medicine

Even though medicine has traditionally been regarded as a profession which provides tremendous job satisfaction, many doctors are finding themselves increasingly dissatisfied with the practice of medicine. In the past , when doctors met, they used to talk about the interesting patients they helped to treat. These days they usually talk about financial stresses, job pressures, bureaucratic hassles and red tape. Doctors are increasingly toying with the idea of changing careers , while others are burning out in their mid-forties. Where has the joy of practicing medicine gone ?

In order to find joy in medicine, we need to find meaning in our profession. Work is an essential part of being alive and physicians are fortunate to work in a job which can provide so much satisfaction . They are presented with new challenges daily ; they can apply their mental abilities and their physical dexterity to successfully solve many of these problems; they are accorded respect and status; and they have control and autonomy . Unfortunately, many doctors no longer work for the sake of working - they’re working for a car, a new house, or a vacation. It’s no longer the work itself that’s important to them, and this is a shame, because there is such joy in doing work well.

We are privileged to help take care of patients, and we need to respect our role, so we can learn to respect ourselves. If you do what you love and love what you do , you will find a higher purpose in life - and if you are passionate about your work , your life will be full of meaning. Getting paid for this should be seen to be the ultimate bonus !

We are fortunate to be doctors, because we can learn so much from our patients. They bare their heart to us, and make us privy to their innermost confidences, so that daily we get a ringside view of human drama, suffering, courage, life and death – the stuff of which life is made ! Doctors have a chance to plumb the depths of the human soul, as they accompany their patients through their suffering. Our work lends itself to contemplation and introspection – allowing us insights which few other people are privileged to have. Our patients can teach us how to live and how to die – and we need to keep our hearts open to their lessons. While it is true that daily exposure to misery and suffering can drain some doctors, causing compassion fatigue; and leave others hardened and unfeeling, these same experiences can also invigorate and rejuvenate you.

Watching patients die should remind you of your own mortality , so that you remember to learn to live each day well . Seeing very ill patients recover should renew your sense of amazement at the marvels of the human body , so that you appreciate the perfection of your own body every day. Observing friends and loved ones provide comfort and courage to the ill should awaken your own feelings of compassion, so that you remember to touch all your near and dear ones with love every day. To live life to the fullest, we need to recapture our sense of wonder at life daily – and being a doctor allows you the privilege of doing that at close quarters !

It is true that physician morale is declining today, and doctors are hard pressed to find job satisfaction. However, instead of focusing our efforts on trying to identify what is wrong with medicine today, we should identify happy doctors and delve into their secrets. I am sure we all know doctors who still look forward to each day as an opportunity to do good, and to become more skilled physicians. We should try to learn from their successes. Many of these happy physicians may never become the president of the medical association, or grab media headlines , or be written about in House Calls, but they are the true stars of our profession, because they have found meaning in their lives. My personal role model is my father, who is one of the most satisfied people I know. His primary source of happiness is his patients , and they have provided him a major source of personal sustenance. He enjoys talking to them, they enjoy talking to him, and his links with them are deep and personal. Even more importantly, I have learned that professional satisfaction does not come from acquiring money, but instead from gaining “social capital” through community ties. He has numerous extracurricular activities , and is very well connected with his family, friends and neighbors, and these social bonds contribute enormously to his satisfaction.

The first rule for being a happy doctor is very simple – it simply means caring for your patients. Treat all your patients like VIPs – whether they come from Dharavi or from London . Remember that the relationship with our patients is at the heart of our professional role – and a healthy doctor-patient relationship can nurture both patient and doctor ! Medicine is really about service, not science - and the true meaning of medicine is found in the relationships we have with our patients. Savor your patients. When a patient thanks you for your work or says that you've become like a family member, stop and relish that moment. Those moments are the real reward for being a doctor, if you can slow down to let them in. When it comes to getting positive feedback, no profession in the world comes close to medicine ! The joy of medicine is in doing good , which is why patients still confer a special status on us – we need to prove ourselves worthy of it..

Find an area of special interest in your field which you enjoy, and acquire a depth of knowledge in this focused area. Once you've mastered an area, then master its intricacies. Not only is it personally rewarding, it'll be professionally rewarding, as well. Your colleagues will refer problem patients in this area to you ( allowing you to become even more expert in the topic), and you will also acquire a reputation amongst patients as being very good in this area.
If you find your practice has become boring, tedious and monotonous, you need to recharge your batteries. Be willing to do something new, even if it involves a risk – after all, if you continue doing the things which bore you, the situation will get even worse ! You can consider hiring an assistant, to take care of the parts of medicine you find boring, so you can concentrate on what interests you. Other doctors have rediscovered joy not by narrowing their scope but broadening it to encompass a new area of expertise – for example, by exploring alternative medicine, such as acupuncture, homeopathy and chiropractic.
Try to publish and present your clinical experiences. This will force you to read the medical literature and provide intellectual discipline as well , as you have to carefully document your experiences and answer your colleague’s queries. Advances in medicine depend upon clinical acumen, and if we apply scientific rigor to our clinical experience , we can all contribute to improving medical practice. Treasure your rare patients and your difficult cases – they can teach you the most !

Develop humility. Often you will find that the reason you are unhappy in your professional life is that you have let your ego get out of control. Practicing medicine can make us feel that we are indispensable, and self-importance is a serious malady that stands in the way of professional satisfaction.

Learn to develop interests and friends outside medicine. While it is true that medicine can be a demanding mistress, don’t let her take over your life. Good doctors are well-rounded individuals , who have an open mind and are curious about everything. Having outside interests will not only make you a better person , it will also help make you a better doctor, as you apply what you learn from other fields to your medical practice. For example, I enjoy playing tennis, and have found that learning how to serve has helped improve my surgical skills by honing my hand-eye coordination.

Do some charitable work – for example, offer a free clinic once a week. One of the best ways of feeling good about yourself is by doing good for others , with no strings attached. The gratitude of the patients you see free of charge is worth much more than any amount of money . As a doctor you have many opportunities for being altruistic – make the most of them !

Don't make the mistake of equating wealth with happiness - the pursuit of wealth only complicates our search for happiness. . As physicians, we should be grateful that we get the opportunity to make a positive difference in the lives of others every day – a goal most humans aspire to. Be thankful daily that you can help others - expressing gratitude is a powerful tool in the search for contentment and self-worth.


Most of us become doctors in order to help others, and all of us get this opportunity to do so on a daily basis, whether we work in Mayo Clinic, or in the heart of rural India. We should remember how lucky we are to belong to such a privileged profession. Even in ancient India, vaidyas were considered to be very fortunate, because their lives offered them the opportunity of fulfilling all the three aims of a good life – dharma ( religious gain, by relieving the suffering of patients); artha ( material gain, by building up a rich practice); and kama ( personal satisfaction, by curing those whom he loves and respects, and by acquiring fame for his expertise). This is as true today as it has been through the centuries ! Medicine is a wonderful way to make a living – be glad you are a doctor and make the most of your profession – for your sake, and for the sake of your patients !

Friday, June 17, 2005

Aetna Research Shows Positive Impact of Consumerism on Health Care Decisions

Aetna Research Shows Positive Impact of Consumerism on Health Care Decisions: "Health care consumerism can be a positive force in the health care marketplace". I would have thought this would be obvious, but this study just documents the fact that if you educate patients, they will utilise the medical facilities you offer them sensibly and rationally ! By comparison, if we continue to allow doctors to make all the healthcare decisions, they will continue to misuse the money by buying the latest medical toys and gizmos ! Everyone does what's in their own best interests - and patients need to come first !

Putting Patients where they belong - at the center of the medical industry !

Consumer Decision Aids Consumer Directed Health Care has become the latest "buzz-word" in healthcare today. The Americans enjoy coining neologisms, most of which are terrible, but I like this one. It should actually be obvious, since all health care is meant to be patient-centred, but doctors often tend to forget this simple fact - that the only reason for their existence is their patients. Today, unfortunately, most healthcare is Doctor Directed Health Care ! This paper from Healthwise describes the tools we can develop and deploy to help patients make their own decisions.

Wednesday, June 15, 2005

PatientINFORM

PatientINFORM: "patientINFORM is a free online service that provides patients and their caregivers access to some of the most up-to-date, reliable and important research available about the diagnosis and treatment of specific diseases." I love the way the internet has made medical information available freely to patients ! Here's another excellent inititiative.

Monday, June 13, 2005

Doctors also have a sense of humour !

Every once in a while I come across something which restores my faith in the medical profession. International Family Planning Perspectives is a medical journal, and typical article titles include: The Impact of Menstrual Side Effects on Contraceptive Discontinuation: Findings from a Logitudinal Study in Cairo, Egypt. Most of these articles are excellent sedatives, since they are full of jargon and technical minutiae which are of interest only to the authors ( and perhaps their mothers). However, I came across this article in the March 2005 issue - Does "CNN " work better than " ABC " in Attacking the AIDS Epidemic ? That woke me up all right ! The author has cleverly used these acronyms to coin his own long-forms. "CNN " stands for Condoms, Needles and Negotiation
while " ABC " stands for Abstinence, Being Faithful and Condom Use. You can bet this is an article I will read - and remember !

Tuesday, June 07, 2005

Rollercoasters

Many people enjoy riding rollercoasters - while others are petrified of them. Interestingly, it's not the actual ride which evokes fear - after all, everyone knows modern rollercoasters are very safe and secure. It's the imagining what will happen to you while you go through the twists, turns, the loops and the bends which is scary. This is why most young kids are fearless when sitting on coasters - their imagination isn't powerful enough ! This is exactly why some patients can breeze through a surgical operation, while others are petrified of the operation theater and dread every minute of it. Once you realise it's your mind which is playing games, you can also learn techniques to cope with this !

Dealing with ghosts

I recently visited SeaWorld in San Diego, and saw a children's 3-D film about ghosts. Watching the film made me realise that we all have to deal with the ghosts in our lives. A ghost cannot "scare you to death" - after all, a ghost is made of ectoplasm and can do nothing by himself. However, if you are scared of a ghost, this fear can scare you into jumping out of the window and leaping to your death. I guess many fears and worries in our lives are like ghosts - and once we realise they have no power over us except what we choose to give them, our lives will become more liveable ! A good example of such a ghost would be the fear of death amongst many patients. It's an irrational fear - after all, there is no reason to believe that death is unpleasant or painful. Why then, so we worry so much about it ? Maybe we need to treat this fear as a ghost and say "Boo " to it !

The best job in the world !

Many patients feel that being a doctor can be very stressful. I remind them that as an IVF specialist, I have the best job in the world - I help women get pregnant, and I get paid for it !

Helping Patients Manage Their Chronic Conditions

"Helping Patients Manage Their Chronic Conditions ": An excellent free report which teaches doctors how to teach patients to take more responsibility for managing their own chronic medical problems. Not only can doctors learn a lot from this , so can the intelligent patient ! Clever tools to teach doctors how to talk so that patients will listen ! I particularly liked their "Ask,Tell,Ask" format for providing information. If you want to know what this is, you'll need to read the report - it's well worth it !
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