Reviewing Standard Pre-Op Tests For Medical Tourists

over treatment in medical tourismI 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?

8 Responses to Reviewing Standard Pre-Op Tests For Medical Tourists

  1. Aziz Denian, MD. says:

    I am not in a position to give a statistics or to get involved in undefined random comments about over-management (Over treatments), but I can assure to follow up all my patient Dx & Rx & $ with real logic payments details at any general and speciality medical management field in Jordan. From my previous 30 years experience within the medical field, I might claim that some patients are frequently overcharged by approximately 30-40 % than the real expenses. If any of you have a patient at this country who needs an open eye observation for their Dx/Rx/$ during their treatment, you might ask them to contact our clinic, we might charge pure 5% of the total bill to cover our time / effort / communications / transportations consumption “if the patient can offer it”, otherwise we will not charge any penny and we will consider our assistance as a part of our community services.
    With Denian’s clinic best regards.
    Dr Aziz Denian.
    Amman – Jordan.

  2. Dr.Ayyappan Thangavel says:

    In our experience only the essential tests which we do for our local patients is what we do for medical tourism patients also,patient safety and quality of care are the cornerstones of our practice,cost cutting or cheap surgeries is not our strategy.

  3. Certainly there is abuse in any system but I do feel that medical toursim often represents a purer form of medicine and better physician-patient relationship than the perverse system that has slowly developed in the US as of late, and will now likely get worse. Bureacracy and often ordering tests or procedures in order to try and make up some income, AND, to stave off that oft unmentioned word:malpractice, is often the case in our current healthcare process. With patients travelling to see the doctor, i can say as a clinician that I will offer them the best and most appropriate treatment to these patients who do not have an agenda, and honest workups/surgical recommendations will bring more patients from that locale in the future. Just my perspective since surgeons dont often write in to these discussions and I hope I am representing our opinions well. Dr. Badia Hand and Upper limb surgeon – Miami

  4. Debasish Mukherjee says:

    I have come across such misuse through over treatment and unnecessary procedure specially in case of insured patient. But in case of Medical tourism the aim should be to reduce time and cost as much possible since the root purpose of Medical Tourism is Cost advantage from his or her own country.

  5. Javier Rodriguez-Vera says:

    Someone discovered fire. I´ve been reporting from 2 years that here on the Algarve there was malpractise, overuse, brives, and missuse. No one appeared to read my reports.

  6. Javier Rodriguez-Vera says:

    Thanks to God anyone sees the light!!! I´ve been communicating overuse, missuse and abuse on the Algarve at least 2 years. I´ve been prized with been fired from my Medical Manager work.

  7. Nasir Mahmood says:

    It is really a considerable aspect/matter as well as medical tourism is concern. The following sentence of your column is impressive.

    “Sometimes these required tests are nominally performed for the sake of risk assessment but in practice may be considered another profit center”.

    My experience is , it mostly happen for extra profit.

  8. Christina deMoraes says:

    The D-Dimer (embolism) should be a no-brainer for everyone. I have been making them mandatory for my patients the moment they step off the plane since 2003 or so when we first heard of them. Before this test became known however, each patient had to submit to a dopplar ultrasound of the lower extremities to rule it out (again, as soon as they arrived). The dopplar IS an expensive test but being done in the name of safety, it’s a worthwhile investment.

    I have not had to deal with a patient “complaining” about a diagnostic test the surgeon felt necessary, however, I have had a patient ASK for tests unrelated to his surgery because he was uninsured in the US and the $100 colonoscopy in Brazil would have cost him much much more back at home. Same goes for a mammogram. It’s amazing how very expensive these tests can be in one’s home country but hearing what “bargain” they are abroad can actually inspire them to get some of these routine but domestically costly ones done while they are able.

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