Ethics

Your patient wants to be a medical tourist—6 things you should do

In medical tourism, the patient takes the trip while it’s the physician back home who may end up in unfamiliar territory. Learn about the medical tourism ethical issues that arise and how to handle them the right way.

The AMA Council on Ethical and Judicial Affairs studied the complexities involved in travel to another country to receive care and has developed guidance for physicians. The council’s guidance has been approved for inclusion in the AMA Code of Medical Ethics.

“Many medical tourists receive excellent care, but data suggest that issues of safety and quality can loom large. Substandard surgical care, poor infection control, inadequately screening of blood products, and falsified or outdated medications in lower income settings of care can pose greater risks than patients would face at home,” says the council’s report on the topic. “Patients who develop complications may need extensive follow-up care when they return home.”  

Here’s what physicians should keep in mind, based on the approved language of the report, “Medical Tourism.”

Be alert to indications that a patient may be contemplating seeking care abroad. It is an opportunity to explore the patient’s concerns and wishes about care and for you to share relevant knowledge. Referral to a specialist with relevant knowledge or other resources—a specialty society or government resources—also is appropriate. 

Become familiar with medical tourism issues. That knowledge, including risks and possible benefits, will support informed decision-making when a patient raises the topic.

Common clinical reasons for medical tourism include transplantation, cardiac care, orthopedic surgery, fertility treatment and, in what the AMA council found was a “significant and expanding” sector, cosmetic procedures. The AMA report underscores a highly problematic area—stem cell transplantation, offered by hundreds of clinics worldwide.

“Other than therapies for blood disorders, there is no evidence that stem-cell-based interventions are efficacious,” the AMA report warns, noting that it is nevertheless offered as therapy for “spinal cord injury, cardiovascular disease, Parkinson’s and a host of other conditions.”

Help patients understand the special nature of risk and limited likelihood of benefit when they desire an unapproved therapy. Often medical tourism is prompted by the desire to obtain treatment unavailable in this country. “Physicians should help patients frame realistic goals for care and encourage a plan of care based on scientifically recognized interventions.”

Advise patients who say they will be seeking care abroad whether follow-up care will be available from your practice. If the answer is no, refer the patient to other options for care.  

Offer your best professional guidance about a patient’s decision to become a medical tourist. In that regard, the conversation is the same as any other regarding appropriate care.

“This includes being candid when they deem a decision to obtain specific care abroad not to be in the patient’s best interests. Physicians should encourage patients who seek unapproved therapy to enroll in an appropriate clinical trial,” the ethical guidance states.

Respond compassionately when a patient who has undergone treatment abroad, without your prior knowledge, seeks nonemergent follow-up care. Factors to consider, if you are reluctant to provide the care, are: the nature and duration relationship with the patient; the likely impact on the individual patient’s well-being; and the burden declining to provide follow-up care may impose on fellow professionals; and the likely impact on the health and resources of the community. If you are unable or unwilling to provide care, there is still the responsibility to refer the patient to appropriate services.

Call for collective action as well

The ethics opinion also looks beyond one-on-interactions between patient and physician to discuss what specialty societies and other professional organizations should do. One is to enhance informed decision-making by supporting the collection and access to outcomes data. Physicians also should advocate for health-professional education about medical tourism and appropriate oversight of medical tourism and the companies that facilitate it.