Medico-legal - The risks of medical tourism for GPs

The MDU's Dr Brigid Simpson advises GPs to make sure patients understand the implications of surgery abroad.

Surgery abroad may not be in an elderly patient's best interest (Photograph: SPL)
Surgery abroad may not be in an elderly patient's best interest (Photograph: SPL)

Medical tourism - when patients travel abroad for elective treatment, such as cosmetic surgery, dental treatment or even fertility treatment, because it is cheaper or more accessible than at home - is growing in popularity.

Figures from the international passenger survey, which samples people leaving the UK, suggest that in 2006, 77,000 people went abroad for medical treatment.1

But it is not without its pitfalls. Research published by the British Association of Plastic, Reconstructive and Aesthetic Surgeons2 found that in 2007, plastic surgeons across the UK saw more than 200 patients for complications after surgery abroad - a quarter required emergency surgery.

GPs' involvement
While UK doctors are not responsible for the treatment provided overseas they may still become involved either before the patient leaves for treatment or after they have returned. This raises a number of medico-legal issues.

If a patient asks you as their GP to complete a medical history form for them to pass on to a doctor who will treat them overseas, you may want to talk to them to ensure they understand what it can entail. For example, you might like to discuss the following issues:

  • The potential for communication difficulties if English is not the first language of the healthcare team.
  • The possibility that the doctor overseas may prescribe medication which may not be available in the UK, or not available to NHS patients.
  • The possibility that in some countries there may be problems in claiming compensation if something goes wrong. You might, for example, wish to suggest they find out about making complaints and claims in the country where the treatment takes place.
  • The question of follow-up arrangements after their discharge, as the patient is likely to return to the UK. You will need to ask the patient to obtain a discharge letter from the doctor overseas. You might also wish to explain that if the patient needs follow-up treatment in the UK, it may not be available on the NHS as quickly as the doctor overseas envisaged. For example, while a patient requiring emergency treatment could be seen on the NHS, a patient needing corrective cosmetic or dental surgery may not be entitled to NHS treatment.

It is advisable to make a note in the medical record of any discussions.

The following scenarios illustrate the decisions which may face GPs if their patients seek treatment overseas. Doctors are advised to contact their medical defence organisation if they have specific queries:

Case Study 1
A patient in his fifties requires varicose vein removal but he wants to have the procedure quickly and has decided to pay for it privately in France. You can think of no clinical reason why he should not go and would like to help him. The patient has asked you to complete a form setting out his medical history.

If, after a discussion with the patient, you think it appropriate to complete the form you should follow the GMC's guidance Good Medical Practice (2006) on writing reports, including not omitting relevant information (paragraphs 63-66). As with any other confidential information, the patient's informed consent is necessary before disclosing these details.

Case Study 2
This patient is an elderly woman with mobility problems. Her son has offered to pay for her to have a hip replacement done in Turkey as he believes it will give her a new lease of life. You are not convinced this is in her best interests, given the length of the journey and the fact she is frail.

If it is your clinical opinion, based on the information the patient has provided, that the journey or procedure is not in your patient's best interests, the MDU advises you to discuss your concerns with her. In this case, the patient may want to explore alternatives in the UK, or to seek your advice on minimising risks. Again, you should make a note of such discussions.

If the patient decides to go ahead with the surgery and develops complications following the treatment, you have the same professional duty to assess her and provide clinical care as with any other patient.

However, given that she may require specialist aftercare, it is important to recognise and work within the limits of your competence and also consider referring your patient to an appropriate colleague.

  • Dr Simpson is a medico-legal adviser for the Medical Defence Union

References
1. Medical tourism: Key facts www.treatmentabroad.com/press/ medical-tourism-facts/

2. Rise of cosmetic surgery tourism threatens patient safety and burdens NHS, BAPRAS, December 2008. www.bapras.org.uk/news.asp?id=62

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