I wonder how many of the 45 medical tests and treatments recently named by U.S. physician groups as possibly wasteful, harmful or simply too expensive are routinely done in medical tourism?

The “List of 45” comprising five tests physicians and patients should questions from each of nine physician groups, contains mostly “do not” suggestions.

Blood clot testing is routine for some medical tourists

One “do” piece of advice from the group – about blood clots – should be noted by hospitals catering to medical tourists, and medical travel facilitators. The physician group recommends that a D-dimer test to rule out blood clots be given for patients with low probability of deep vein thrombosis (DVT) or pulmonary embolism (PE).

In some medical destinations, D-dimer testing to check for DVT susceptibility has become routine, but it is not commonly done across the board. Given how much concern and cautionary writing appears in the media about the danger of blood clots for international traveling patients, doctors and care managers may be wise to review their medical tourism pre-surgery protocols to include the D-dimer as part of the medical tourist’s routine screening. This is not an expensive test.

Overtreatment in medical tourism

I’ve sat in a consult once in which I felt my client was being pushed by the surgeon toward having a colonoscopy on the basis of marginally elevated PSA test results. Surgeons don’t bully or strong-arm, but they don’t have to. Because of their perceived status and their persona, a strong suggestion works as well or better than a heavy dose of bullying or a stern admonishment.

In this case, the patient chose to have the colonoscopy, my input being reduced to raising my eyebrows and suggesting that she delay her decision for six months or a year. Even the surgeon agreed that there was no urgency and a year’s delay would be acceptable… but he didn’t advise any delay. The surgeon’s enthusiasm came from a well meaning concern for the patient. My hesitation came from a well meaning concern for my client.

The patient’s planned surgery and recovery went ahead after the colonoscopy. But the delay and extra procedure added to her costs. After she returned home to China, in the comfort of familiar surroundings and with her husband questioning why her medical bill was so much higher and why she had a colonoscopy, she complained to us about our management of her care, not the surgeon’s strong urging for her to have the test.

Was this enthusiastic overtreatment? According to the American College of Physicians, false positives are likely to result in unnecessary invasive procedures that potentially cause harm through over treatment and misdiagnosis.

One doctor puts it another way: How will the test result change the care? If the results won’t change anything, perhaps the test should not be done.

Unnecessary procedures for medical tourists

For many medical tourists who go abroad for surgery, pre-operative workups commonly include a chest x-ray. According to the “List of 45”, the American College of Physicians now suggests that patients need not have pre-operative chest radiography in the absence of suspicion for intrathoracic pathology or cardiopulmonary symptoms.

There may be a reason for all pre-op testing to include chest x-rays. You may disagree that D-dimer tests be included or that medical travelers be encouraged to go through with screening tests such as colonoscopies.

What do you do as a medical travel facilitator, or as a patient, if the hospital requires certain tests that at home would be optional? Sometimes these required tests are nominally performed for the sake of risk assessment but in practice may be considered another profit center.

What has been your experience?