[NA]Medical Tourism[NA]

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Dave Taylor
I am reading and hearing more & more about this, we had an acqu. go to Thailand for a pacemaker implant; $8K all-up plus travel and 100% success, no complications.
Another foaf got a hip implant in India, she is finally walking around without a limp and looks 20 years younger, cost $5K.
I did a search for 'medical tourism disasters' and surprisingly few hits. Also some insurance companies are discovering that it is cheaper to pay for all of travel, hotel and procedure 'over there' than it is to pay for their usual fraction.
Anyone have any experience (other than an unfounded dread of the unknown)?
I have no particular need; just curious.
 
And when something DOES go wrong... good luck finding someone to help pick up the pieces..

How are you going to manage follow up care and any potential complications?
 
I'll bet they'll generate a chart just like they would here. Many of the medical personnel are trained in the West.
 
I am reading and hearing more & more about this, we had an acqu. go to Thailand for a pacemaker implant; $8K all-up plus travel and 100% success, no complications.
Another foaf got a hip implant in India, she is finally walking around without a limp and looks 20 years younger, cost $5K.
I did a search for 'medical tourism disasters' and surprisingly few hits. Also some insurance companies are discovering that it is cheaper to pay for all of travel, hotel and procedure 'over there' than it is to pay for their usual fraction.
Anyone have any experience (other than an unfounded dread of the unknown)?
I have no particular need; just curious.
Medical tourism might be an option for somebody with assets but no or inadequate health insurance. You might get a nice room and possibly your own full time nurse. Physicians are often have similar training compared to those working in the U.S. The equipment in these hospitals can be top notch.

Now for the downside. Nobody has 100% success and/or no complications for any procedure worth traveling halfway around the world. Not even the top specialists at Mayo Clinic have a perfect record. Medical tourists in India have contracted infections that no antibiotic can treat. If something goes wrong you will have little or no recourse. One reason prices are lower is that practically no money goes to the lawyers. If you think getting a special issuance medical is hard now good luck getting all of the paperwork together from a foreign hospital. If the reports are not in English good luck getting them translated.
 
<SNIP> Medical tourists in India have contracted infections that no antibiotic can treat. If something goes wrong you will have little or no recourse. One reason prices are lower is that practically no money goes to the lawyers. If you think getting a special issuance medical is hard now good luck getting all of the paperwork together from a foreign hospital. If the reports are not in English good luck getting them translated.
We have some pretty nasty bacteria in USA hospitals too.

As for medical reports, they are in English in India (at least the places used by my relatives). I don't know about other countries but India was singled out.
 
I've known people to travel to Mexico for extensive dental work (crowns, veneers, etc) when they were wanting all of their teeth worked on. Considerably cheaper than here in the US.
 
We have some pretty nasty bacteria in USA hospitals too.

As for medical reports, they are in English in India (at least the places used by my relatives). I don't know about other countries but India was singled out.
Yes we do. MRSA and VRE, however we still have antibiotics to fight these infections. Superbugs resistant to all known antibiotics are emerging in countries such as India and Pakistan.
http://epinews.com/Newswire/2010/08...tens-global-spread-of-supergerms-study-finds/

I have nothing against medical tourism but you must pick the hospital and physician carefully. It can be much less expensive. I might even consider it if I ever lose insurance coverage. Canadians have been known to come to the U.S. for medical care. I had a patient who went to a hospital in Mexico. Even though it was a in a city known for tourism (Cancun?), all of the reports were in Spanish. This was not much of an issue but it could have been if they were in another language. Make sure that all of the reports and notes are written in English and hand carry them back with you.

I think the best way to improve quality and cost in medicine is to encourage competition and get the lawyers under control. Effective competition will only occur in the event of near total deregulation of medicine which is not going to happen in the U.S. anytime soon. Until then you can always go to another country for medical care. It's your health, good luck.
 
Yes we do. MRSA and VRE, however we still have antibiotics to fight these infections. Superbugs resistant to all known antibiotics are emerging in countries such as India and Pakistan.
http://epinews.com/Newswire/2010/08...tens-global-spread-of-supergerms-study-finds/

<SNIP>
You may also look closer to home. Similar organisms are being created because we feed livestock antibiotics to prevent them being sick: http://www.liebertonline.com/doi/abs/10.1089/fpd.2006.0066
 
ref. responses above:

-nosocomial infections; I was unable to find actual rates to compare the situation between countries. Surely all countries have such complications - heck, the US apparently has 2 million per year with 100,000 deaths as a result. Without actual data, the fear of a mrsa etc is based solely on hypothesis or anecdote (which is worthless to evaluate a theory).

-do you really think US medical professionals will deny you assistance, if you have a complication or need follow-up....based upon where the original medical care was provided? I am having a hard time believing there is any substance to that argument. "Ah, treated in Thailand - sorry you'll have to leave."

-getting a chart translated afterwards would be an annoyance, but I can't see it as a valid reason to not seek out-of-country care. I doubt anyone who was determined to go would even consider it.

-I don't think we have a basis to blame tort lawyers for the problem with medical lawsuits, high malpractice premiums and medical costs. Our legal system allows such claims, so the blame truly lies elsewhere.

Gary's link was to an article that is more a teaser, no hard info - wish I could see the actual reports. Even then, without epidemiological studies it won't mean much other than 'we should be frightened'.

Jack, is that really a scientific article at all? It looks sort of like a narrative rehash of general ideas. Not really a study or containing substantive material. Although there is not much doubt to your point.

All good thoughts, that is what I ask for, thanks.
 
<SNIP>
Jack, is that really a scientific article at all? It looks sort of like a narrative rehash of general ideas. Not really a study or containing substantive material. Although there is not much doubt to your point.
More of a review of some of the literature at the time it was written. Liebert publishers certainly isn't Nature or Science but they aren't too bad either.
 
ref. responses above:
-nosocomial infections; I was unable to find actual rates to compare the situation between countries. Surely all countries have such complications - heck, the US apparently has 2 million per year with 100,000 deaths as a result. Without actual data, the fear of a mrsa etc is based solely on hypothesis or anecdote (which is worthless to evaluate a theory)
I did not think that I would need to do a formal literature search to make a point. Go ahead and believe whatever you want. For all I know you might be an Infectious Disease specialist.
-do you really think US medical professionals will deny you assistance, if you have a complication or need follow-up....based upon where the original medical care was provided? I am having a hard time believing there is any substance to that argument. "Ah, treated in Thailand - sorry you'll have to leave." -getting a chart translated afterwards would be an annoyance, but I can't see it as a valid reason to not seek out-of-country care. I doubt anyone who was determined to go would even consider it.
I never said that a medical tourist would be denied care. There are times when it is very helpful to have medical records immediately available. Sometimes I can get them, sometimes not. It can be like pulling teeth to get records from a U.S. hospital after hours, probably impossible to get them from a hospital in another country. If you have medical records from another country consider carrying them with you. Also, don't expect me to hunt down a translator in the middle of the night, I probably do not have the luxury of time anyway. Another problem is that even if the reports are in English, drug names are often different and this can take time to sort out.
-I don't think we have a basis to blame tort lawyers for the problem with medical lawsuits, high malpractice premiums and medical costs. Our legal system allows such claims, so the blame truly lies elsewhere.
We really disagree here.
Gary's link was to an article that is more a teaser, no hard info - wish I could see the actual reports. Even then, without epidemiological studies it won't mean much other than 'we should be frightened'.
I'm sorry. I thought that is was a good summary. If you think my reference is bogus look it up in The Lancet Infectious Diseases. http://www.thelancet.com/journals/laninf/issue/current The Lancet is a respected medical journal. As inappropriately as antibiotics are used here, they are often used much more recklessly in some other countries. I have seen some bad infections, not pretty. I do not want one.

I am reading and hearing more & more about this, we had an acqu. go to Thailand for a pacemaker implant; $8K all-up plus travel and 100% success, no complications.
Another foaf got a hip implant in India, she is finally walking around without a limp and looks 20 years younger, cost $5K.
I am amazed that you believe this obviously ridiculous marketing hype, but I need rigorous epidemiological evidence. I did not think that would be necessary for the intended audience.

I do not have anything against somebody seeking an alternative to traditional U.S. health care. Medical tourism can be useful and cost effective but be aware of the pitfalls. It's your body, not mine.
 
I had a dear friend who needed a hip two years shy of Medicare coverage. She went to Thailand for the replacement. Had a complication with the first procedure, and needed a more extensive procedure to redo the damage a few days later, but was well-pleased with the care she received by her western-trained surgeon, and the month of recovery time seeing the beautiful sights there. However, when she needed the other hip replaced a couple of years later, I note she stayed not only in this country, but this county. Then her knees were also replaced here.
What conclusions? I believe she found it considerably less troublesome to stay home, once she hit the magic 65, and it was less expensive out-of-pocket to do so.
 
Gary,
I hope you will come to know me as others have here....I am foremost an info seeker....try not to take my challenges for others to provide more detailed and current info as a personal affront; that would never be my intent. I appreciate all input, yours included.
On the topic of foreign medical care, I can find little info except for what anecdotes I can glean locally. That isn't enough for me to either recommend it or use it (or for that matter, to shun it).
Until we have more hard data, I think the jury is out on everything from success rates to complication rates.
 
Gary,
I hope you will come to know me as others have here....I am foremost an info seeker....try not to take my challenges for others to provide more detailed and current info as a personal affront; that would never be my intent. I appreciate all input, yours included.
On the topic of foreign medical care, I can find little info except for what anecdotes I can glean locally. That isn't enough for me to either recommend it or use it (or for that matter, to shun it).
Until we have more hard data, I think the jury is out on everything from success rates to complication rates.
I don't take anything personally. I hope that I have not come across as being too snarky. I enjoy a good debate.

I think you are being somewhat selective on the quality of evidence you require, less for the positive aspects and greater for the complications.

BTW, There are many types of pacemakers and only the simplest device could possibly cost as little as 8K if you include the implant fee and travel. Most people who need a basic pacemaker need one right now so medical tourism for this would probably be impractical. Somebody who needs a Biventricular pacemaker or defibrillator might be able to get one of these elsewhere as these are often done as an elective procedure. PM me if you know anybody who might need a cardiac device and I can probably supply more information.
 
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I think you are being somewhat selective on the quality of evidence you require, less for the positive aspects and greater for the complications.

I feel you may have missed my very last sentence, which I offer as evidence to the contrary, Gary -

Until we have more hard data, I think the jury is out on everything from success rates to complication rates.

So, my mind remains completely open to either any information or a conclusion on the matter!



BTW, There are many types of pacemakers and only the simplest device could possibly cost as little as 8K if you include the implant fee and travel.

The one I heard about is pretty simple; he has to crank a handle attached to a device implanted in his chest to keep the battery charged! :D
 
A friend of mine recently went to Mexico to have the gastro surgery for weight loss. Two of his friends and his wife had gone before him. He further said that the quality of care was extraordinary and it was less than half the price than local doctors. The doctor had been trained in the U.S.

I asked about complications and follow-up care and he said that it was no problem and anything needed to treat and follow-up issues were covered by insurance up here. Just not the original procedure.

Tell me our medical system doesn't need an overhaul.


And when something DOES go wrong... good luck finding someone to help pick up the pieces..

How are you going to manage follow up care and any potential complications?
 
I never said that a medical tourist would be denied care. There are times when it is very helpful to have medical records immediately available. Sometimes I can get them, sometimes not. It can be like pulling teeth to get records from a U.S. hospital after hours, probably impossible to get them from a hospital in another country. If you have medical records from another country consider carrying them with you.

I've been treated and had crew treated world wide. The only place I didn't leave with my records is in the US. I have also always had them in English. I once had to get a deckhand an appendectomy in Tahiti, total bill....$10. Luckily we were only half a day out or I would have had to break out my surgical kit....
 
Tell me our medical system doesn't need an overhaul.
It does need a major overhaul. Unlike our lawyer buddies who think their system is just great, I admit that our medical system is too expensive. Unfortunately, we are moving in the wrong direction heading toward total government control. We can expect to have a system that runs as efficiently as industry did in the former Soviet Union. The real solution is massive deregulation to force medical providers and hospitals to compete on the basis of cost and quality. We will also need to revise civil law to allow the flexibility of different "standards of care" and reduce the need for defensive medicine.
The higher cost in this country is not primarily the result of greedy physicians. The greatest expense for hospitals is labor. Labor costs are much higher in the U.S. than other countries. I doubt that they have nurse's unions in countries where medical tourism is prevalent. Our medical system is heavily regulated, directly by the government and indirectly by trial lawyers and this substantially increases costs. Another problem is the indiscriminate use of high priced technology. Patients are usually shielded from exorbitant costs and want everything done in spite of the fact that the benefit might be negligible or even nonexistent. Who cares if somebody else is paying the bill.
 
Actually, we do have a pattern of "defensive medicine", though I can hardly blame the docs. With the wealth of technology available, why not rule out all the possibilities. Since you can't nuke it from orbit, it's the only way to be certain. Not only that, but it could come in handy if you get sued. But all that technology is expensive, and everyone is shielded from the cost. I may be the only one to ever turn down medical tests, which tells you what a lousy patient I am.

I imagine a lot of things have to change in order to make it better. However, folks are making money hand over fist in the business. Used to be docs, but I don't think they really do anymore. Whoever it is, they have lobbyists and pet politicians to try their damndest to maintain the status quo. Can't entirely blame them, the status quo is very, very good to them. So what we wind up with, after a huge concerted effort, is a halfway measure that really doesn't please anyone. Welcome to the American way.
 
I've been treated and had crew treated world wide. The only place I didn't leave with my records is in the US. I have also always had them in English. I once had to get a deckhand an appendectomy in Tahiti, total bill....$10. Luckily we were only half a day out or I would have had to break out my surgical kit....
That's nice. One of my patients returned from Cancun with 10 to 20 pages of medical records all in Spanish. Did you have complete records? Foreign hospitals that support the U.S. military may be required by the DOD to supply all records in English.

I think $10 is a great price for an appendectomy but I wonder who is subsidizing the cost or what corners they are cutting. You can't get a bag of IV fluid for $10. What did they use for anesthesia, a mallet?
 
I am reading and hearing more & more about this, we had an acqu. go to Thailand for a pacemaker implant; $8K all-up plus travel and 100% success, no complications.
Another foaf got a hip implant in India, she is finally walking around without a limp and looks 20 years younger, cost $5K.
I did a search for 'medical tourism disasters' and surprisingly few hits. Also some insurance companies are discovering that it is cheaper to pay for all of travel, hotel and procedure 'over there' than it is to pay for their usual fraction.
Anyone have any experience (other than an unfounded dread of the unknown)?
I have no particular need; just curious.
OK, I just got some more info. I spoke with one of the representatives from a major pacemaker company. The hospital's cost for the least expensive single lead pacemaker is about $3,000. The most expensive device is a tricked out biventricular pacemaker defibrillator that costs around $22,000. They sell the exact same devices all over the world except for China which manufactures it's own devices to different specs under license. The cost overseas is probably less but the exact cost is unknown. It usually takes about an hour to implant a single lead device 1 to 2 hours for a two lead pacemaker and 2 to 6 hours to implant a biventricular pacemaker. This procedure is performed in a cath lab and requires 2 or 3 nurses or technicians in addition to the physician. The patients usually stay overnight in the hospital and get a chest x-ray the next morning. You might be able to get a basic pacemaker in another country for 8K.

The rep also told me about a medical tourism misadventure. The patient has a weak heart and already had a biventricular pacemaker defibrillator. The device was checked just before he went to Thailand for a stem cell treatment and it was working perfectly. Stem cell treatment is experimental in the U.S. and definitely not ready for prime time. The idea is to inject stem cells which will hopefully take residence in the heart, transform into heart muscle cells and help the heart to become stronger. After the treatment (which did not help) he was told he had a problem with his device and it had to be replaced and that he could not wait until he got back. They charged him full price, about $40,000 to have it replaced. He also paid a small fortune for the unsuccessful stem cell transplant. This was basically a high priced vacation.
 
A friend of mine recently went to Mexico to have the gastro surgery for weight loss. Two of his friends and his wife had gone before him. He further said that the quality of care was extraordinary and it was less than half the price than local doctors. The doctor had been trained in the U.S.
I asked about complications and follow-up care and he said that it was no problem and anything needed to treat and follow-up issues were covered by insurance up here. Just not the original procedure.
Weight loss surgery is covered by most major insurance companies as well as Medicare. They all have rules to determine who is eligible based on body mass index, how long they have tried to diet and at least one other medical problem such as diabetes or degenerative joint disease aggravated by obesity. In other words, not everyone who is overweight will be covered. The bariatric surgeon usually requires a cardiology evaluation which often results in some type of stress test. In Mexico, they can avoid all of these impediments and proceed right after a successful wallet biopsy.
 
That's nice. One of my patients returned from Cancun with 10 to 20 pages of medical records all in Spanish. Did you have complete records? Foreign hospitals that support the U.S. military may be required by the DOD to supply all records in English.

I think $10 is a great price for an appendectomy but I wonder who is subsidizing the cost or what corners they are cutting. You can't get a bag of IV fluid for $10. What did they use for anesthesia, a mallet?

Gov't/tourism subsidizes the cost. The hospital was equipped the same as you would expect from any western Hospital and the doctor was French.

As for my records completeness, it was just minor illness/injury stuff so it was a simple record of treatment.
 
ref. responses above:

-do you really think US medical professionals will deny you assistance, if you have a complication or need follow-up....based upon where the original medical care was provided? I am having a hard time believing there is any substance to that argument. "Ah, treated in Thailand - sorry you'll have to leave."

I've seen it happen within the same hospital. Just because YOU want a new doctor or a second opinion, the other surgeons in the same hospital as one where someone MIGHT have botched something.... tend not to touch it. Obviously, "emergency" EMTALA rules start to apply at some point, but thats not in a doctors office, and it falls to whomever is on call at the hospital you go to.

Refusing to see a "complicated" patient that they didnt complicate is a way to keep THEIR complication rate and infection rate is unaffected, which affects their insurance and their reputation... not to mention... If the second guy really cant make you whole, and you decide someone has to pay.. who is easier to sue? Some dude overseas? or the schmuck who tried to help the cheapskate?

I'm telling you what I've actually seen. Be VERY cautious about getting surgery outside the country without having someone lined up IN ADVANCE for follow up care.. who knows you are going outside the country..

I'm betting those rich guys who come to the US for surgery have the means to travel for follow up, or stay for the short term until the outcome is all but assured.
 
I've seen it happen within the same hospital. Just because YOU want a new doctor or a second opinion, the other surgeons in the same hospital as one where someone MIGHT have botched something.... tend not to touch it. Obviously, "emergency" EMTALA rules start to apply at some point, but thats not in a doctors office, and it falls to whomever is on call at the hospital you go to.

Refusing to see a "complicated" patient that they didnt complicate is a way to keep THEIR complication rate and infection rate is unaffected, which affects their insurance and their reputation... not to mention... If the second guy really cant make you whole, and you decide someone has to pay.. who is easier to sue? Some dude overseas? or the schmuck who tried to help the cheapskate?

I'm telling you what I've actually seen. Be VERY cautious about getting surgery outside the country without having someone lined up IN ADVANCE for follow up care.. who knows you are going outside the country..

I'm betting those rich guys who come to the US for surgery have the means to travel for follow up, or stay for the short term until the outcome is all but assured.
A valid concern. The on call docs at a hospital are required to see true emergencies. If you have a non life threatening complication you might get referred back to your original surgeon for treatment. Another possibility is that you might get sent to an Infectious Disease specialist for treatment of an infection. As a general rule, physicians are not required to accept anybody as a patient and can dismiss a patient with 30 day notice. During the 30 day period the physician is only required to provide emergency care.
 
One of the potential difficulties with going overseas is that there are no assurances about the standards used in the operating room for sterility, etc. They do not have JCAHO, OSHA, etc looking over their shoulders and setting guidelines, etc. Yes, it is a major PITA insuring compliance, but at least to me, most of the JCAHO stuff actually makes sense (don't block fire extinguishers with equipment, don't stack stuff to the ceilings as a fire hazard, make sure your sterilizers actually work, etc, and other practical items )and was written by people who actually did the job, as compared to some of the newer medicare rules, which were written by bean counters or practitioners who are far removed from actually treating people.

One of my physician colleagues had his mother return to their native country of Russia for a hip replacement. The x rays showed an implant that was at least 20 years behind the times in terms of technology and thinking- it would clearly not last as long as one done well in the United States. Is this worth saving a few thousand dollars?

Ever look at the prevalence of HIV infection in Thailand? I recall that in adults, it is about 40% of the population. Would you want to have a surgical procedure in a country with an HIV rate so high, no understanding of their standards for sterility, and risk the potential for the need for blood products? Even in the states you will see periodically episodes regarding issues with sterility, and both in Madison, WI, as well as the Milwaukee VA hospital, both were shut down for periods of time because of these concerns. An HIV infection or hepatitis C might not show up for months afterward, long after the surgical procedure, let alone the need for prolonged IV antibiotics for an acute infection or one acquired in a foreign country?

So, cheaper less initially, but in the long run, after seeing what can potentially happen following surgery, not worth it.

Americans want and demand the best and most immediate health care in the world, but don't want to pay for it. As it currently exists, it is unsustainable. The doctors and hospitals are being squeezed, and yet there is a glut of MRI scanners, out patient surgery centers, and other money making businesses out there that drive the cost of health care. The CEO's of places like HealthSouth and other HMO's made millions, while they nickel and dime their customers about every lab test and procedure.

It is inevitable that Americans will see longer waits to see their physicians, less services, less access to elective procedures or fancy tests and technology. If they continue to want and demand immediate access to all of these, we simply need to realize that it will be very costly, otherwise, stand in line.

Ever see new hospital construction going on next to the highway just down the road from an existing facility? Who do you think ultimately pays for this? Who do you think profits from this?

These big HMO's and hospital businesses will be the next Wall street or automotive crash of the United States.
 
To Gary's point, I work in a tertiary care academic facility. We see a disproportionate number of surgical misadventures and problems that are created by other US trained physicians.

Some examples- patient comes to an outside hospital ER, surgeon on call does not even come in to see patient, but says, send him to our hospital. Doesn't bother to assess injuries or even make call to us asking for help. Or, patient sent to my office with major infection or fracture- no notes or call from initial treating doc. Had a similar episode just a few weeks ago where a patient was seen in an outside hospital, not appropriately assessed, and sent to us with an obvious limb threatening condition that even a medical student could recognize. Patient underwent immediate emergency surgery, but still might lose his leg due to delay in care. A simple operation done in the first hospital would have prevented any of this.

So, would I want to treat someone who did not have a life or limb threatening condition that was maltreated by another doc? Absolutely not. Obviously, if an emergency that required immediate intervention, then of course. But if the patient could safely and effectively be treated at an outside hospital closer to home, then they would be referred back.

Imagine how this problem multiplies if the initial treating physician was in another country? Again, it just would not be worth the risk to save a few thousand dollars. An infected hip replacement and its treatment can easily cost 250k and a year of surgical procedures and antibiotics, so the risk/value scale needs to be looked at from this perspective.
 
So, would I want to treat someone who did not have a life or limb threatening condition that was maltreated by another doc? Absolutely not.
I don't blame you.
Obviously, if an emergency that required immediate intervention, then of course. But if the patient could safely and effectively be treated at an outside hospital closer to home, then they would be referred back.

Imagine how this problem multiplies if the initial treating physician was in another country? Again, it just would not be worth the risk to save a few thousand dollars. An infected hip replacement and its treatment can easily cost 250k and a year of surgical procedures and antibiotics, so the risk/value scale needs to be looked at from this perspective.

If the original surgeon is in this country you would probably also get named in the suit. Trial lawyers must name any physician who might possibly be involved in malpractice and you get to try to convince the court you are not at fault. A surgeon from another country is out of reach of our legal system so the unfortunate patient might try to go after the next surgeon to recover something.
 
We see a number of surgical problems... .

Some examples- patient comes to an outside hospital ER, surgeon on call does not even come in to see patient, but says, send him to our hospital. Doesn't bother to assess injuries or even make call to us asking for help. Or, patient sent to my office with major infection or fracture- no notes or call from initial treating doc. Had a similar episode just a few weeks ago where a patient was seen in an outside hospital, not appropriately assessed, and sent to us with an obvious limb threatening condition that even a medical student could recognize. Patient underwent immediate emergency surgery, but still might lose his leg due to delay in care. A simple operation done in the first hospital would have prevented any of this.

So, would I want to treat someone who did not have a life or limb threatening condition that was maltreated by another doc?

So, a patient realizes that he was mistreated/undertreated and seeks alternate therapy or revision and you dare to tell him that he is SOL???
Where is Hippocrates in all of this? Or are you saying that the patient needs to find medical in a foreign country because US physicians are too spooked by lawyers?
 
He is saying neither, Gwen...
He is saying a physician is no different than any other person... A physician is not forced to provide a service based merely upon that person's demand and against the physician's choice... Physicians are neither slaves nor indentured servants... We do have a few rights remaining - damn few according to ATLA...

(some exceptional circumstances have resulted in courts ordering physicians to treat a patient they previously dismissed but those are exceptional circumstances - the only dialysis clinic in an area with a non compliant patient, for one case)

As far as this Hippo guy, that all went out the window when the courts ruled that medicine is just a business subject to the same antitrust laws as junkyards and gas stations... If you don't like that idea go yell at your congress critters, it was not the doing of doctors...

denny-o
 
-I don't think we have a basis to blame tort lawyers for the problem with medical lawsuits, high malpractice premiums and medical costs. Our legal system allows such claims, so the blame truly lies elsewhere.

DAVE

Please!!!!! Tell me you are joking when you say this. I can not believe that anyone would truly think this. Dont give me it is the systems fault because our system is created by lawyers. Out of the 540 current members of Congress (including 5 non-voting members), 236 hold law degrees (58 Senators and 178 Representatives). That makes 44%. I forgot to mention the president is also a lawyer.....
 
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-I don't think we have a basis to blame tort lawyers for the problem with medical lawsuits, high malpractice premiums and medical costs. Our legal system allows such claims, so the blame truly lies elsewhere.

I dont blame the lawyer.

I blame the person who hires the lawyer, who has the expectation of the US Legal system being a form of the lottery with odds stacked in their favor.

For every junkyard lawyer out there, there is a client who hired them.
 
So, a patient realizes that he was mistreated/undertreated and seeks alternate therapy or revision and you dare to tell him that he is SOL???
Where is Hippocrates in all of this? Or are you saying that the patient needs to find medical in a foreign country because US physicians are too spooked by lawyers?
I can't find anything in the Hippocratic oath about cleaning up after a foreign doctor's mistake. If it makes you feel better I would not refuse to treat somebody who wants a new physician.

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.
I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

I am glad I reviewed this. I knew that you can't fool around with patients but this also applies to anybody in their household including their slaves. No wonder house call have fallen off.
 
<SNIP>
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.

<SNIP>

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
<SNIP>

Must be tough on doctors these days- digitalis is deadly only a little above prescribed doses; many other medicines can also be toxic as well.

Surgeons also have a tough time following the oath too.
 
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.


Must be tough on doctors these days- digitalis is deadly only a little above prescribed doses; many other medicines can also be toxic as well.

Surgeons also have a tough time following the oath too.
Digitalis has been largely replaced by newer drugs from those evil greedy profit seeking pharmaceutical companies.

I've used the knife. Where do I turn myself in?
 
I have had 400 lb patients come to see me with hypertension, diabetes, and on oxygen, and also with bad knee arthritis. Despite the fact that the only thing to help them would be a knee replacement, I have had to tell them that they are not a good surgical candidate. It is not easy to take away their hope, but I do not believe I have a Hippocratic obligation to do an elective operation that might leave the patient permanently on a ventilator or without a leg due to an infection or amputation.

I have also had patients come to me demanding a procedure or implant that is not indicated in my medical opinion. After trying to explain why it might not be in their best interests, if they continue to insist, they simply need to go elsewhere. They often interpret this as my being a bad surgeon - if so, so be it.

So, unless it is an immediate life or limb threatening condition, I am not obligated by any ethical or legal standard to provide care.
 
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