By Dr Tomislav Meštrović, MD, PhD
A list of international destinations where patients travel to obtain a wide array of procedures is growing, and they range from low to high risk according to possible complications or other negative outcomes. Hence it is vital to speak openly with the international physician about potential complications and how to minimize them prior to any medical procedure.
Diverse standards with regards to hospitals and physicians can be a problem, as each country usually has its own licensing and certification protocols. Increased familiarity with destination country protocols is necessary, and all potential risks should be taken into account before making a final decision to travel abroad.
Medical tourism increases the risk of nosocomial infections, also referred to as healthcare or hospital acquired infections. For example, if needles are reused between patients or other unsafe injection practices are occurring, serious infections such as hepatitis and HIV can be transmitted.
Infections with multiresistant organisms, the spread of noroviruses (common cause of acute gastroenteritis) and mycobacterial infections after cosmetic surgery are well documented cases of medical risks. Patients who cross borders in seek of a medical care are also potentially exposed to infections that they would not normally encounter, thus posing a public health risk when they return home.
An apparent increase in so called “transplant tourism” in the last twenty years is also followed with a higher incidence of tissue rejection after the operation and critical infectious complications among transplant medical tourists, when compared to other transplant patients. Furthermore, blood supply in some countries comes predominately from paid donors and may not be adequately screened, which can additionally endanger patients.
Traveling long distances after surgical procedures can also pose certain risks such as deep vein thrombosis and pulmonary embolism. The risk of these adverse events can be reduced by drinking plenty of water, exercising legs while seated and taking a walk every 2 to 3 hours on a long plane trip. Medical compression stockings and anti-clotting medications can also be prescribed for high-risk patients.
Ethical and legal risks
Patient autonomy and informed consent both represent a cornerstone of bioethics, which can sometimes mean a concerning issue for medical tourists. In the context of medical tourism, informed consent can be influenced by ambiguous or incomplete information on websites, problems in obtaining veracious information about success rates and the quality of care in destination facilities.
Even under optimal circumstances it is often difficult to obtain informed consent for medical procedures; the international dimension raises those concerns even more. Limited health literacy (coupled with aforementioned inadequate access to accurate information) can result in patients’ inability to make a thoroughly informed decision about medical tourism and to eventually accept the risks of seeking healthcare in another country.
Countries may also have different standards of medical ethics. For example, a therapy that is considered experimental in one country (like stem cell therapy) can be commonly used in the private care institutions for medical tourists in other countries. Similarly, the medical ethics related to organ transplantation often differ from country to country.
If problems arise, patients might be left without the opportunity to seek damages in malpractice lawsuits, due to the multiple jurisdictions involved and the lack of clarity in terms of which law should apply. Valid legal solutions to these issues are difficult to establish, thereby transferring pressure on patients’ healthcare systems at home – including health and safety professionals – to address them in a makeshift fashion.
Last Updated: Sep 17, 2014