Is there anything wrong with our medical tourism?

ON Dec 18, 2017, Australian Broadcasting Corporation News reported a fatal case of medical tourism in Malaysia, but this was given little coverage here.

The news centred on an Australian coroner’s inquest over the death in 2014 of 31-year old Australian medical tourist Leigh Aiple, who paid RM109,530 (A$35,000) for a 360-degree tummy tuck, extensive liposuction, an upper eye lift, a chin tuck, a thigh lift, chest sculpting and lip filler. All these were done in the space of five days in Malaysia.

The first surgery alone lasted 10 hours. This mammoth undertaking was done on the 124kg Aiple at a Kuala Lumpur clinic. He died within 24 hours of his arrival in Melbourne, with his 360-degree wound having burst open. The cause of death was deep vein thrombosis, resulting in pulmonary embolism, meaning clot or clots in the legs shooting off into the lungs.

This piece of news was given scant coverage in Malaysia because Aiple’s death and the subsequent inquest both took place in Australia.

Expert reviewer Professor Mark Ashton, president of the Australian Society of Plastic Surgeons and former head of plas- tic surgery at the Royal Melbourne Hospital, said there was no regulation on medical tourism with bundle packages designed for patients wanting the maximum number of surgeries in the shortest period of time, irrespective of risk.

Coroner Caitlin English found that the treatment and care Aiple received was “well below Australian standards”. Medical negligence lawyer Emily Hart said: “The standards in Malaysia were met in this case, but they come nowhere near the standards here in Australia. These companies are putting profit over patients’ safety.”

These sweeping statements with a broad brush have tainted the Malaysian healthcare services, but who can blame the Australians?

It is understandable that many governments and private hospitals promote medical tourism because it brings valuable foreign exchange into the country and profit to the hospitals. But in the fervour to promote medical tourism, good clinical practice and common sense must not be compromised. With bundled packages, healthcare workers are under pressure to treat within the stipulated fee, and when complications arise, they may compromise.

Hence it is obvious that the most suitable procedures for medical tourists are low-risk, non-emergency, elective or “cold” cases like cataracts. Even with emergency high-risk surgery, the surgeon should at the very least ensure that the surgical wound has healed, the patient is able to mobilise, eat and drink before discharge.

Private hospitals in Melaka and Penang serve many medical tourists from Indonesia. As a physician, I treat non-surgical patients with medical conditions. Many medical tourists expect to see their doctors only once. Often they would ask for a supply of medicines for six months, to be continued on their own in Indonesia, if suitable. Good clinical practice does not acquiesce to this request.

I often tell my first-time Indonesian patients that a doctor’s duty of care is not just to sell medicines. I would like to know if my medicines work, how my patients respond to the medicines I have prescribed, whether the dose needs to be increased or the medicines changed, and whether there are any side effects. What if they develop an allergic reaction after two doses of medicine from the six months’ supply? The remaining medicine will go to waste. We then negotiate for a follow-up date. If it is impossible for them to return for a follow-up due to logistic reasons, then I will give them only a short supply of medicines and tell them to see another doctor in Indonesia. I will only give six months’ supply of medicines to stable patients, whose illness is well-controlled.

The expectation to see doctors only once and to be cured is also prevalent among local patients. Patients should consider the duration of their symptoms. If they have been symptomatic for weeks, months and years, then they are likely to require more than one clinic visit.

In this regard, there are many types of diseases. The common cold may need only one clinic visit. At the other end of the spectrum, hypertension, diabetes, coronary artery disease and chronic kidney disease require lifelong treatment. In the case of illnesses like peptic ulcer, depression and anxiety, a course of treatment may suffice.

In conclusion, common sense and good clinical practice with follow-up monitoring must prevail – whether we are dealing with medical tourists or local patients. A PHYSICIAN Melaka