Understanding Medical Tourism

For Bariatric Patients

Medical Tourism

Medical tourism or health tourism is

the travel of people to another country for

the purpose of obtaining medical

treatment in that country.

Benefits of Medical Tourism:• Affordability

• Access to faster care

• Access to care not available at home

• Access to highly trained specialists

Risks of Medical Tourism:• Safety

• Lack of oversight

• Lack of accountability

• Fraud

• Complications, Infections, and

life-threatening or poor results

• Lack of follow-up and support

• Canada and the U.S. have high

standards of quality and regulatory

agencies and oversight organizations to

help insure competence and

experience.

• Many medical tourism providers lack

this oversight, putting patients at

undue risk.

Medical Tourism

It is almost impossible for

patients to know whether a

foreign hospital meets even

minimal standards of

safety and care.

• For patients travelling outside of

Canada, there is a lack of preoperative

testing and minimal follow-up care, if

any.

• This is especially unsafe for bariatric

patients, who require pre-and post-

follow up and support.

Research

Do Your Research?• It's not enough to tell someone to "do

their research".

• Just speaking to people who had

surgery at unsafe places often doesn't

reveal useful information.

• Seeing videos or testimonials are not a

good way to determine if a place is safe

?

Research is NOT:• Talking to others who have been there

• Looking at videos or testimonials online

• Speaking with other patients in chat

rooms or online about their experiences

• Company websites can

make almost any

claims they want

Research IS:

• Verification of surgeon’s credentials

directly from the appropriate authorities

• Verification of licenses, certification,

inspections and memberships for clinics

• Asking specific questions about safety,

processes, protocols, equipment and

checking the answers for accuracy and

transparency.

Looks Aren’t Everything

• Just because a place looks

clean, and they tell you it is

safe does not make it so

• If a clinic is not regulated or

inspected independently,

profits will likely come before

patient safety

• Hospital acquired infections and many

complications are often diagnosed after

the patient is long-gone

Medical Tourism Realities

Understanding

Foreign Laws

• There is little recourse for Canadian

patients who experience fraud

Medical Tourism Realities

• Financial responsibility for complications

falls on the patient and their families

Medical Tourism Realities

• Foreign hospitals won’t start treatment

without payment, even if the

complication is theirs.

Medical Tourism Realities

Risks to be Aware of

• improperly trained or certified medical

staff,

• inadequately sterilized operating

theatres,

• outdated equipment and instruments,

• early discharge and inadequate

postoperative care

• as well as significant language barriers.

Risks to be Aware of

• This puts patient safety at risk and

leaves any complications on the

doorstep of the Canadian public health

system - often without the local medical

experts required for effective treatment

of bariatric complications.

Demand Evidence

The only guarantee patients have to safe

medical care are independent proof of:

– Safety Standards

– Processes

– Regulation

– Oversight

These basic standards are missing in

most foreign countries.

• Consumers have few ways to determine

whether the facility and provider they

are considering have the credentials,

experience, training or even familiarity

with the procedure that is being

claimed.

Buyer Beware• Without oversight and regulation, any

provider can claim to be safe, while in

reality they are cutting costs by failing to

provide standards of care that are

expensive to provide, such as proper

sterilization and safe OR equipment and

staff with appropriate credentials.

Center of Excellence• A Center of Excellence Designation

is the only way to check if the

hospital or surgical facility is in

compliance with the standards we

would expect from a U.S. or

Canadian surgical facility.

• This is the only

independent verification

possible for consumers.

Common Practices

in Foreign Countries

Medical Tourism

• Common practices in unregulated

clinics:

– Instead of titanium staples, stainless steel

staples meant for veterinary clinics

– OR tables propped up on 2x4 wood blocks

– Missing OR equipment such as

capnographers to measure oxygen levels

– Reused laparoscopic equipment shared

from patient to patient

– Unlicensed staff

Actual OR

In Mexico

Ongoing Support

Doubles

Weight Loss

It’s Not Just Surgery• Weight-loss surgery is NOT just about the

surgery.

• In fact, any experienced and trained

bariatric surgeon will tell you that it is really

only worth about 10 percent of the success

equation.

It’s Not Just Surgery

• The other 90 percent is found in the pre-

care, the education, the skill training,

the support portion, the follow-up care,

and the behavior and lifestyle changes,

among others.

Quality Care Costs Money

• When a patient seeks surgery out of the

country, there is usually little to no pre-

surgery care, screening,

testing/evaluation, education or skill

training simply because there is not time

in the trip or in the schedule and it is

costly to provide.

Quality Care Takes Time

• Appropriate pre-surgical programs can

take anywhere from four weeks to six

months

• (excluding patients with particular

issues that require treatment longer

than six months).

Medical Tourism

• The pre-surgical medical

assessment, evaluation and

training are almost universally

missing in medical tourism,

and patients may never even

see an internist.

Decisions are made based on

ability to pay, rather than safety.

Questions to Ask

• What are the

surgeon’s credentials?

• Have you checked

directly with the

governing bodies?

What Happens if there is a complication?

What is their complication rate?• If they give you a number, or %, how do they know? How do they

track?

• Where do you enter your medical information? Who has it?

• What kind of medical information system do they use?

• Who do they report their data to?

• Is there oversight?

• How can you verify their claims? There should be reporting agency

such as the SRC

Questions to Ask

Questions to Ask

• Does the facility have appropriate

emergency and back-up measures and

systems like an emergency room or

critical care facility?

Questions to Ask

• What other medical procedures does

the clinic perform?

• How many operating rooms does it

have?

• Is there a back‐up OR, prepped and

ready to operate in, in case of an

emergency complication?

Questions to Ask

• Is the OR dedicated to bariatric patients or is

it used for everything from kidney transplants,

hip replacements, to neurosurgery to

hysterectomies?

• Have they just rented an OR from a private

clinic (this is common practice in Mexico with

both less reputable private clinics and

established hospitals).

• If the surgeon is just renting an OR, you need

to ask yourself why.

Questions to Ask

• A clear warning sign of danger would be

a clinic that specializes in an area

unrelated to bariatric surgery – ie.

Obstetrics Centers, Renal Units, Day

Surgery Centers, etc.

Questions to Ask• Are they using black market implants,

medications, surgical implements and

other materials or equipment?

• Veterinary supplies or re-used

equipment is common practice in

unregulated clinics and hospitals.

Questions to Ask

• Is the surgical suite really sterile, or is it

just separated from the waiting room by

plastic sheeting or open doorways?

• Have they sterilized the OR from the

previous patient?

• Are you at risk for blood born

diseases such as hepatitis

or HIV?

Questions to Ask

• Are the medications,

supplies and other

materials outdated,

recalled, expired or

stored correctly?

Questions to Ask

• Are they using equipment no longer

considered safe from any time after the

second world war?

Questions to Ask

• Is the equipment tested? By whom?

• When was the last inspection?

Questions to Ask

• Will there be a language barrier I have

to overcome in trying to get information?

• What happens if I begin to put the

weight back on?

• Who will help me then?

Is the surgeon really a

doctor?

• Check to see if the surgeon is

really who they say they are and

actually has the credentials they

are advertising.

• Just like in Canada, both the

United States and Mexico have

the equivalent of the College of

Physicians and Surgeons.

• You can find out if that surgeon

really is "Board Certified" or if they

are just claiming to be.

Is the surgeon really a

doctor?

• You can also ask for

the Doctor's License

number for any

Mexican doctor.

• Every surgeon will

have two numbers,

one for general

medicine and one for

general surgery.

Checklist: Medical Team

• Who is the Anesthesiologist?

• What are their credentials?

• The surgeon is very important, but it’s

actually the anesthesiologist who keeps

you alive during surgery.

Checklist: Medical Team

• Who is the Anesthesiologist?

• In Mexico, a general practitioner can

take a several day course on

anesthesiology and that’s all that stands

between a patient and potentially

serious complications, such as brain

damage and even death.

Unlicensed ClinicsOnce you have

established whether

the surgeon you are

considering is

licensed, now you

must research the

quality of the surgical

team and facilities.

Checklist: Facilities

• Is the facility licensed?

• By whom?

• When does its license expire?

• What surgeries is it licensed for?

• When was the last inspection?

• Who did the inspection?

Checklist: Facilities

• Is the Facility a Dedicated Bariatric

Center or a Rented OR?

• How safe is the facility?

• Is it a private clinic?

• Is it in an upscale area or in a

rougher part of the city?

• Do patients share a recovery room?

Checklist: Facilities

• Do the staff all speak English?

• Language barriers are a serious health

risk, especially in the event of an

emergency.

Checklist: Follow Up

• What kind of follow-up do they have?

• If the surgeon doesn’t speak English,

how can he communicate with you or

your family doctor if needed?

• What kind of staff do they have here in

Canada?

• Do they have nurses, nutritionists, and

counselors on staff?

Checklist: Follow Up

• What kind of training does their staff

have?

• What about support groups? Is it a valid

support group that adheres to the

standards and protocols of the ASMBS?

• Are there support group materials and

lesson plans or are they simply social

gatherings?

Checklist: Follow Up

• What kind of tracking do they do?

• What procedures do they have in place

in the event that you have inadequate or

slow weight loss or gain?

• What type of postoperative guidelines

and information do they provide? Is it in-

depth, or is it one page?

When I’m Back Home

• Who will do my blood tests?

• Can I find a practice at home that

will let me come to their support

group?

• Do I understand the importance of

a support group?

When I’m Back Home

• If I have emotional difficulties, who will

see me for these?

• How will I find reliable resources and

educational materials?

• Who can I call when I have questions or

am experiencing problems?

When I’m Back Home

• What if I have a complication, who will

see me?

• What if I develop adhesions or a hernia

– will a local surgeon take on my case

to help me?

• How will my surgeon communicate?

When I’m Back Home

• Can I trust that an emergency room in

my community will know how to treat

me, especially if I arrive unconscious

and unable to relay my situation?

• What happens if there isn’t qualified

medical professionals locally?

When I’m Back Home

• Who will monitor my nutritional status?

• What ongoing blood work will I need?

• What if I need medications for specific

issues related to my obesity or my

surgery?

• How will my family doctor

know what to expect?

Questions to Ask

• Will I be made aware of what I am

supposed to do following surgery, when

I am supposed to do it, for how long,

why I am supposed to do it, and how it

will help me?

Checklist: Your Privacy

• What happens to your medical information?

• Who has access to it?

• What safeguards do they have in place to

protect your privacy?

• What happens to your information after

surgery?

• How long are records kept?

Verify, Verify, Verify

• Google can be an effective research

tool. Type in your surgeon's name and

the following keywords to see what

comes up:

– Lawsuits, Infections, Malpractice,

Complaints, Disciplinary action, Arrest,

Legal, Court, Reviews, Scams,

Complications. Beware, etc.

Seeing is Not Believing

• Just because a surgeon has documents,

credentials, certificates and licenses that look

authentic – does not mean they are. You

must check directly with the organizations in

question.

Questions to Ask• Does the surgeon require a preoperative

diet? For how long?

• Are their differing requirements depending on

BMI?

• A good indication of the quality of the surgeon

is the depth and quality of the pre- and post-

operative instructions.

If I’m Already There

• Poor or run-down transportation,

• A bad neighbourhood,

• Nurses, etc. taking blood without wearing

gloves,

• Medical team with a lack of English skills,

• Being allowed food 24 hours before surgery

• Untidy examining rooms,

• Not staying overnight in hospital after surgery

If I’m Already There

• What to do if you arrive and there are

red flags?

– Be prepared to leave

– Have a plan in place

– Someone should know where you are

– Listen to your intuition

– If something doesn’t feel right, do not

continue with the surgery

– Your life is not worth the risk

Medical Tourism

Is potentially contracting HIV or Hepatitis

or finding out that you have stainless steel

staples meant for animals worth saving a

few dollars?

You are Worth It

• If after reading all this, you are still

considering medical travel, then

remember: you get what you pay for.